Implementation of a Registered Undergraduate Student of Nursing (RUSON) program: The nurses’ perspective

Clinical nurse educators' experience of new graduate nurses' transition into practice following the COVID-19 pandemic. A qualitative study

BACKGROUND

Graduate registered nurses transitioning into clinical practice are known to feel uncertain about their ability to provide high-quality patient care and meet professional expectations. These concerns may have been magnified following the COVID-19 pandemic.

AIM

To explore clinical nurse educators' and new graduate nurses' perspectives on the transition into clinical practice following the COVID-19 pandemic.

DESIGN

An exploratory descriptive qualitative study design was used to allow for flexible interaction with the study participants to collect rich data and themes to develop.

SETTING

The study was conducted at a large not-for-profit healthcare facility in Victoria, Australia.

PARTICIPANTS

There were two (2) groups of study participants: six (6) clinical nurse educators and ten (10) graduate year registered nurses.

METHODS

Individual, semi-structured interviews were conducted via teleconferencing.

RESULTS

Three (3) key themes explored the experiences of new graduate nurses and the support provided by clinical nurse educators during their transition to clinical practice. The professional challenges of clinical nurse educators following the COVID-19 pandemic were also explored. Five (5) subthemes addressed: increased motivation of graduate nurses entering clinical practice, importance of opportunities for kinaesthetic learning, and relationship building in the clinical environment to strengthen integration into the health service. Pre-registration nursing roles contributed to greater confidence and a smoother transition to clinical practice. Clinical nurse educators identified gaps in communication and clinical skills, but also resilience and determination as key attributes of graduate nurses. Structured study days early in the graduate year resulted in rapid improvements in the graduates' kinaesthetic skills and confidence to practice.

CONCLUSIONS

Completing undergraduate education during the COVID-19 pandemic impacted pre registration nursing students' clinical and communication skill development. Opportunities to work in structured and supported clinical roles prior to registration Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation eased the transition into clinical practice. During their graduate year factors mitigating transition stress included: targeted educational support and integration into clinical teams.

Midwives experience of working with maternity assistants: A qualitative study

INTRODUCTION

The midwifery workforce is essential for delivering safe, high-quality maternity care, however, global staffing shortages pose significant challenges. To address these issues, incorporating midwifery assistants, including undergraduate midwifery students into the model of care has been proposed as a strategy to support midwives and maintain effective service delivery.

AIM

This study explores the Registered Midwives' experiences working with Midwifery Assistants (MAs) in an Australian tertiary maternity service.

METHODS

This study employed a qualitative exploratory design and was conducted using semi-structured interviews with 9 midwives who had experienced working with MAs in the tertiary maternity care setting.

RESULTS

The discussion highlighted three main themes from the experiences of these midwives working with MAs in tertiary maternity settings. Firstly, all types of MAs are valuable, though their scope of practice and initial knowledge base vary. Secondly, MAs enable midwives to focus on midwifery care, though their potential could be expanded. Finally, undergraduate midwifery student working as MAs gain valuable professional experience, benefiting both themselves and the midwives they assist, despite concerns about role blurring.

DISCUSSION

Midwives are essential in maternal and newborn care, however, declining numbers in Australia, result in maternity care models needing review. Maternity assistants can be integrated into care models, providing vital support. While MAs help midwives focus on clinical tasks, role blurring, and limited numbers can be challenges. Expanding MA roles, especially for midwifery students, may enhance care quality and reduce midwives' workload.

Factors associated with newly graduated nurses' work readiness during a pandemic: A cross-sectional study

BACKGROUND

Newly graduated nurses may experience reality shock and leave the career early, if not adequately prepared. The pandemic has significantly impacted nursing education, clinical placements, working conditions and employment opportunities, leaving newly graduated nurses' work readiness unknown.

AIM

To investigate the work readiness and its associated factors of newly graduated nurses who studied and graduated during a pandemic.

DESIGN

A descriptive, cross-sectional correlational study design was employed.

SETTINGS

The study was conducted at a large public health service in Victoria, Australia.

PARTICIPANTS

Newly graduated registered nurses who studied during the pandemic and graduated between January 2022 and June 2023 (N = 206).

METHODS

Participants were recruited between November 2022 and June 2023. Participants' self-perceived work readiness was measured using the Work Readiness Scale for Graduate Nurses, covering personal work characteristics, work competence, social intelligence and organisational acumen. Pearson correlation, multiple regression and hierarchical logistic regression analysis were applied to test the relationship between explanatory variables and participants' work readiness.

RESULTS

Mean (SD) values were 50.7 (14.6) for personal work characteristics, 100.5 (18.8) for work competence, and 58.2 (12.4) for social intelligence. Median (IQR) for organisational acumen was 145.5 (18.0). Prior Australian registered nurse or enrolled nurse experience significantly predicted personal work characteristics (β = 0.16, p = 0.037), while previous overseas registered nurse experience significantly predicted work competence (β = 0.14, p = 0.049). Participants who were native-English speakers had a significantly lower work competence (β = -0.15, p = 0.032). Being a female (p = 0.002, 95 % CI = 1.75, 13.21) and the length of a final clinical placement (p = 0.033, 95 % CI = 1.02, 1.59) significantly predicted organisational acumen.

CONCLUSION

Despite challenges encountered during the pandemic, participants reported a relatively high self-perceived work readiness. Influencing factors include individual characteristics, clinical placement experiences, and previous healthcare employment.

Experiences of undergraduate nursing students and new graduate nurses in paid employment models and health-related work influencing the transition to practice: a qualitative systematic review protocol

OBJECTIVE

This review aims to synthesize qualitative literature exploring the experiences of undergraduate nursing students and newly graduated nurses who are employed for less than 1 year in clinical settings after graduation. It will focus on those who had paid employment and health-related work experience during their undergraduate studies, examining the influence of these experiences on the transition to practice.

INTRODUCTION

Nursing professionals undergo a transformative journey, starting from envisioning themselves as nurses to developing professional identity and competence. However, the initial transition to nursing practice often poses challenges for undergraduates and newly graduated nurses. To ease this transition, gaining additional clinical experience through paid employment or health-related work during undergraduate studies can be beneficial.

INCLUSION CRITERIA

This review will include qualitative studies on the experiences of undergraduate nursing students and newly graduated nurses in paid employment models and health-related work. No restrictions on the publication date or country will be applied; however, only English-language publications will be included.

METHODS

The JBI methodology for qualitative systematic reviews will be employed. Searches will be conducted in MEDLINE, Embase, Emcare (Ovid); CINAHL Complete (EBSCOhost); and ERIC (ProQuest), along with gray literature in ProQuest Dissertations and Theses and Google Scholar. Study selection, quality assessment, and data extraction will be conducted as per the JBI methodology. Findings will be synthesized using meta-aggregation, and a ConQual Summary of Findings will be created.

REVIEW REGISTRATION

PROSPERO CRD42024520724.

Introduction of a Registered Undergraduate Student of Nursing workforce: A qualitative study of student and registered nurses

AIM

To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020.

DESIGN

A qualitative descriptive study was undertaken using individual interviews and focus groups.

METHODS

Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi-structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken.

RESULTS

Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement.

CONCLUSIONS

This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university-level education and clinical placement, the employment model can create a third space for student learning via on-the-job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Impact This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID-19 pandemic. This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce. Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice. In addition to university-level education and clinical placement, this employment model creates a third space for learning via on-the-job training.

REPORTING METHOD

COREQ guidelines were followed in the reporting of this study.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Student Employment Models for Undergraduate Nurses and Midwives in Australia: A Scoping Review

Introduction

Evidence has shown that throughout their undergraduate years, many nursing and midwifery students obtain paid employment in a wide variety of clinical and non-clinical positions. Across Australia, inconsistencies exist in the models of clinical employment available to these student groups. Previous Australian studies have described the employment of undergraduate nursing and midwifery students in regulated and unregulated clinical roles. No studies have reported on the various regulated roles available to both student nurses and midwives in Australia. The purpose of this scoping review is to identify and synthesize evidence related to nursing and/or midwifery students employed in regulated and unregulated clinical roles in Australia.

Methods

This scoping review utilized published recommendations for data screening, abstraction, and synthesis. One of the authors, a librarian, undertook systematic searches in CINAHL Complete (1937-present), Emcare on Ovid (1995-present), Scopus (1969-present), and Ovid MEDLINE(R) (including Epub Ahead of Print, In-Process, and In-Data-Review & Other Non-Indexed Citations, 1946-present). The initial searches were completed in April 2019 and repeated in March 2021 and May 2022 to identify any new literature. Manual searching of reference lists in the included papers was also undertaken, together with selected organizational websites. The extracted data included the lead author, date, title, study design, study sample and location, and key findings.

Results

From the 53 items retrieved, 23 peer-reviewed studies met the inclusion criteria and were included in the review. All items were published between 2011 and 2022. Only four of the studies focused upon student midwives. Undergraduate nursing and midwifery students in Australia obtain paid employment in a variety of regulated and unregulated clinical roles.

Conclusion

The literature reported here demonstrates that there are differing models, nomenclature, educational requirements, and pay scales in place for student employment in clinical roles across Australian states and territories.

Improving the health assistant in nursing employment model through entry to practice nursing student perceptions: a cross-sectional study

IMPACT STATEMENT

Graduate entry to practice nursing students offer direction on how to improve the Health Assistants in Nursing employment model.