Graduate Nurse Practice

I have hired a Graduate Nurse (GN) as part of my team. What are appropriate practices for a GN?

• The purpose of a GN license is to enable new graduates to begin consolidating their nursing knowledge, skills and judgment. It is the optimal time for managers and staff to support and enable GNs as they transition fully into the RN role.
• GNs are not yet RNs and cannot function as or replace RNs. GNs cannot individually be assigned charge nurse responsibilities (1). It is helpful, however, for GNs to partner with RNs who are performing this role for the GN to further develop their skills and judgment, and to develop a deeper understanding of the role.
• The CRNS sets professional practice limits for GNs who have not met all the requirements for registration as an RN. GNs cannot independently perform Registered Nurse Specialty Practices (RNSP). When GNs have successfully completed the employer-provided education and have the required competencies to safely perform the RNSP, they may do so under the direct supervision of an RN who has employer approval to perform the RNSP (2).
• GNs are obligated to know and adhere to their professional scope of practice.
• The team is responsible to know and understand GN scope of practice to appropriately assign client care to GNs and to support them to function within their role.
• GN applicants must ensure they are licensed prior to beginning employment. Employers must also confirm that GN employees are licensed prior to the GN initiating clinical practice (3).
• In areas where GNs are employed, an RN must be at work and available to direct the work actions or performance of the GN in a collaborative practice. Collaborative practice shall be defined as a process which involves the GN and RN working together in each other’s presence, as necessary. In areas where Registered Psychiatric Nurses (RPN) practice, an RN and/or an RPN may supervise a GN (4).
• Budgetary pressures must not compromise the regulatory requirements for GN practice and supervision.

I am a manager with two GNs that just completed their orientation to the unit.  Can I put them into the schedule where they are responsible for a client care team on evenings and weekends?

No. GNs cannot replace an RN and placing the GNs into the schedule does not negate the need for an RN to coordinate or provide client care. Supervision of GNs is vital to ensuring they have the support and resources to access immediately if they have questions or concerns about a client.

Can GNs perform RN Specialty Practices (RNSP) independently?

No. GNs may contribute to RNSPs while working under the direct supervision of an RN once the GN has successfully completed the appropriate employer education. Once they are licensed as an RN and have developed the competencies, they may independently perform RNSPs. One example is immunization administration. For example, GNs may be able to administer flu shots within a facility while being supervised by an RN who has the required competencies and who is supported by policy to conduct an immunization program.

Can GNs be supervised by an LPN?

No. GNs work in this role to understand their responsibilities as an RN on a particular team. Transitioning from the student role to the RN role takes time and mentoring by a professional with the same responsibilities. The transition period is best supported when GNs work under the supervision of RNs, and in collaboration with all members of the health care team.

What level of supervision is required for GNs?

When the GN begins employment, and for as long as required, the RN provides direct supervision in the practice setting at the point of care. As the RN determines that the GN has increasing competence and critical thinking in the practice setting, the level of supervision may change. As the GN demonstrates consolidation of their registered nursing skills and judgment, supervision can be decreased to indirect supervision. It is important to note that GNs must always be supervised—either directly or indirectly while they transition into the role of autonomous practitioner.

CRNS Resources

Graduate Nurse Practice Guideline (2020)

Code of Ethics for Registered Nurses (2017)

Registered Nurse Practice Standards (2019)

Registered Nurse Entry-Level Competencies (2019)

RN Specialty Practices Guideline (2020)

External Resources

Nursing the Future

Transition to Practice for Newly Licensed RNs