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had to carry identifying different factors that affected them

The participants described wearing their maroon distinguishing epaulettes as an aspiration they had always wished for while they were students. They expressed how, when one is newly qualified, these epaulettes would be worn everywhere feeling so excited and proud to have what they had always imagined. The following participant quotes express the joy of wearing their maroon epaulettes, but with a quick realisation of the responsibility that they would have to bare. The immensity of the amount of responsibility and accountability suddenly dawned on the participants as professional nurses.

“As a student when you see maroon epaulettes, it was something that you used to want…but…emm…you don’t realise the responsibility that goes with it…emm...once you get them for the first weeks it’s on rental…in that you wear them everywhere you go cause you are so excited and proud to have them” (Participant 7, female, 41 years)

Being newly qualified professional nurses is a unique experience. According to Järvinen, Eklöf and Salminen (2018:191-192), there is a big difference compared to being nursing students, primarily related to responsibility. The nursing profession requires expertise, decision-making skills and responsibility; as newly qualified professional nurses, feelings of insecurity regarding responsibilities affected their professional confidence and competence. The role transition into newly qualified professional nurses begins with challenges that create instability and makes change necessary (Van Rooyen, Jordan, ten Ham-Baloyi & Caka, 2018:35). The following participants’ quotes highlight the effects and realisation of the responsibility that came with their new role.

“These maroon epaulettes are really heavy…I can’t hide behind anyone anymore, everything I do I am responsible and everything that everyone else does I am still responsible” (Participant 7, female, 41 years)

“At first I used to report incidents and everything that concerns the patients but then since I have qualified the responsibility is on me…” (Participant 3,

female, 39 years)

A participant shared her experience that wearing these maroon epaulettes caused people to stare at you as it stood out as a device which people looked up to.

“The other thing is that you come with maroon epaulettes everyone is looking at you” (Participant 1, female, 25 years)

The first year of practice is recognised as the most stressful part of the transition into a professional nurse (Innes & Calleja, 2018:62). Although the newly qualified professional nurses had celebrated the marvellous achievement of finally wearing

the maroon epaulettes they had dreamed of, this excitement was soon overshadowed by the huge responsibility they came to know.

The participants described feeling uncomfortable and uneasy when they first started out in the clinical setting. A comparison was done from being students to being qualified, and as a student there was always support and supervision provided to them. There was a struggle of adaptation for the participants as they now found themselves as the supervisor, which caused anxiety and fear of not knowing what to expect from the responsibilities they faced (Bennett, Grimsley, Grimsley & Rodd, 2017:97).

As newly qualified professional nurses, they felt exposed with no one to hide behind. A participant expressed these fears in the following quote:

“Like the very first day I was uncomfortable, uneasy because all of a sudden

…I was a student all along having someone to back me up and now all of a sudden I had to be the leader…I had to be the standing person, I had to lead my juniors which for me I was kind of scared…scared because I didn’t know what to expect…” (Appeared deep in thought) (Participant 2, female, 29

years)

A participant also highlighted the fact that there was some preparedness, but only to a certain extent. Difficulties arose when responsibility was now on the newly qualified professional nurse who was no longer a student.

“I feel that we are actually well equipped for being prepared as a newly qualified…the trouble comes at the fact that as a student you are not really responsible and now when you are qualified now...You have to take responsibility…” (Participant 5, female, 25 years)

The task of leading others was new to them, resulting in great fear of not knowing what the expectations were of them as newly qualified professional nurses in this leadership role. Role transition is a challenging process for newly qualified professional nurses; one that is unfamiliar and that comes with new expectations

(Järvinen, et al. 2018:191). Newly qualified professional nurses have their own expectations of the clinical setting, only to experience a significant challenge upon entering the clinical setting when their expectations meet true reality. A study by Innes and Calleja (2018:62) found that research has highlighted a theory-practice gap among newly qualified professional nurses which was evident in role-related knowledge, skills and clinical thinking, and therefore a reality shock occurred upon entering the clinical setting.

Participants emphasised that it was a vast difference from being a student. They were now in the significant role of being a newly qualified professional nurse with major responsibilities towards their qualifications.

“It’s a big change from being a student and now you are in this big role”

(Participant 2, female, 29 years) (hand movements while speaking - seemed overwhelmed by thoughts)

“The trouble comes at the fact that as a student you are not really responsible

and now when you are qualified now...You have to take responsibility… serious responsibility for your qualification” (Participant 5, female, 25 years)

Indeed, the transition from being a student to being a professional nurse was significantly recognised by the participants; however, the new role attached feelings of fear and anxiety, and was therefore viewed as a role that overwhelmed them. The participants were suddenly aware of the enormous responsibility that is attached to their new role as newly qualified professional nurses. This reality of their role change with multiple responsibilities was experienced as a heavy responsibility with ‘big shoes’ that needed to be filled. The emotional impact and anxiety about all the risks and heavy workload increased their weight of responsibility. This was evident in the following participants’ quotes:

“Once start actual work in the ward and you the only RN and you the only one there, Doctors rounds and you following out orders and getting all the shouting from everybody around you emm…that’s when you realise the actual

responsibility that comes with it…ya its big shoes that need to be filled.”

(Participant 7, female, 41 years)

“It felt like…It is a heavy responsibility” (Participant 5, female, 25 years)

The participants expressed feelings of being burdened, which was difficult to adjust to and they therefore felt the weight of the loaded responsibility in their new role (Erol, Upton & Upton, 2016:62). The significance of responsibility became well- known to the participants when they were alone and had to face challenges. On entering the clinical setting, newly qualified professional nurses face a rude awakening from the supportive comforts of once being a student to facing multiple challenges as they learn to navigate through the complexities of the healthcare system (Weaver Moore, Sublett, Leahy & Bradley, 2017:429).

“You don’t know responsibility until you are faced with responsibility…and all of a sudden you are alone.” (Participant 2, female, 29 years)

In reality, the true meaning of the word ‘responsibility’ came to life for a participant when she was confronted as being the accountable individual with multiple responsibilities.

“Once you start actual work in the ward and you the only RN and you the only one there, doctors rounds and to following out orders and getting all the shouting from everybody around you emm…that’s when you realise the actual responsibility that comes with it…ya its big shoes that need to be filled”

(Participant 7, female, 41 years)

“Like the RN used to be responsible for everything but now even whether you are the junior you also liable and responsible now, yes anything happens yes all responsible but they will ask for the RN, and ask where I was. So I have to be responsible, hands-on, alert and on your toes.” (Participant 6, female, 37

A realisation dawned on the participants that the real responsibility is that of a huge and different role, a transition that no longer has a student title but the title of a qualified professional nurse who takes on responsibilities (Kaihlanen, et al. 2018:3). This transition is a critical phase as emphasised by Baumann, Hunsberger, Crea- Arsenio and Akhtar-Dinesh (2018:373), which facilitates the integration of newly qualified professional nurses into the clinical setting.

3.7.1.2 Category 1.2: Experiences of profound self-doubt about their own