Solving the Retention Puzzle: Let's Begin with Nursing Orientation

Capturing New Nurses' Experiences and Supporting Critical Thinking: Text Network Analysis of Critical Reflective Journals

This study analyzed the contents of critical reflective journals written by new nurses during their orientations using a text network. This study aimed to find ways to reduce turnover and improve clinical field adaptability among new nurses. The authors analyzed the content of reflective journals written by 143 new nurses from March 2020 to January 2021. Text network analysis was performed using the NetMiner 4.4.3 program. After data preprocessing, frequency of occurrence, degree centrality, closeness centrality, betweenness centrality, and eigenvector community were analyzed. In total, 453 words were extracted and refined, and words with high simple frequency and centrality were "incompetence," "preparation," "explanation," "injection," "time," "examination," and "first try." "Medication" had the highest frequency of occurrence, and "incompetence" was the most important keyword in the centrality analysis. In addition, component analysis and eigenvector community analysis revealed three sub-theme groups: (1) basic nursing skills required for new nurses, (2) insufficient competency, and (3) explanation of nursing work. Significantly, this study is the first to use the text network method to analyze the subjective experiences of the critical reflective journals of new nurses. In conclusion, changes are needed to improve the education system for new nurses and promote efficient sharing of nursing tasks.

Relationship between Psychological Distress and Demographic Characteristics among Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

The Baptist Health Lexington Nursing Orientation Progression Tool: A Methodological Study

OBJECTIVE

The purpose of this study was to develop and test a tool to monitor a nursing orientee's progress to competence.

BACKGROUND

The literature suggests that, during orientation, consistent documentation and communication among educators, preceptors, and nurse leaders facilitate a timely progression to independent practice for new nurses.

METHODS

A 2-phase methodological study was conducted. Nurse educators clarified goals, identified essential competencies, and developed the Baptist Health Lexington Nursing Orientation Progression Tool (OPT). The tool was used to monitor orientees' progression through orientation.

RESULTS

Content validity assessment of the OPT (content validity index = 0.98) demonstrated strong validity. Testing of the tool revealed 31 nurses completed orientation early, 12 completed orientation on time, and 18 nurses required extended orientation time. All requiring an extension were new graduates.

CONCLUSION

The OPT guided preceptors to facilitate timely completion of orientation among newly hired nurses. Findings suggest that new graduates may need more assistance than experienced nurses.

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice

CONTEXT

Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition.

OBJECTIVE

To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review.

RESULTS

Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance.

CONCLUSIONS

Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

Ensuring the Future of Perianesthesia Staffing: A Perianesthesia Nurse Residency Program

Recruitment and retention of nurses into the perianesthesia environment remains an ongoing challenge in the face of a national nursing shortage. An insufficient supply of experienced critical care nurses exists to fulfill the staffing needs of perianesthesia departments. Literature describes the impact of successful orientation programs on retention and employee engagement. To compensate for the diminished candidate pool and to improve retention, a nurse residency program was created. The program develops non-critical care experienced nurses into postanesthesia care unit-specific critical care nurses over the course of 1 year. Eight months after implementation, the vacancy rate decreased to 0%. This article details the development and implementation of a perianesthesia nurse residency program.

Managing support for newly qualified practitioners: lessons learnt from one health care region in the UK

AIM

The study mapped the support provided for newly qualified practitioners across Kent, Surrey and Sussex.

BACKGROUND

Newly qualified practitioners require support and guidance to facilitate their transition from student to their new role as qualified practitioner. Professional bodies advocate that programmes be provided but the type and intensity of that support is variable.

METHODS

Telephone interviews were conducted with 24 people delivering support for newly qualified practitioners across professions in 13 different health care trusts. Documents (n = 41) related to support programmes were analysed. Two case study site visits and a knowledge exchange conference of 45 delegates completed the data collection. Data were analysed using the constant comparative method of analysis.

RESULTS

Support for newly qualified practitioners was largely idiosyncratic to profession and Trust. Evidence emerged of a conceptual shift from basic competency acquisition toward a corporate induction programme.

CONCLUSIONS

Interdisciplinary programmes can provide generic transitional support, but the newly qualified practitioners favoured skill acquisition to help them to be effective in their new role. Measuring the impact of newly qualified practitioner support on patient outcome and the practitioner is required.

IMPLICATIONS FOR NURSING MANAGEMENT

A career pathway for those who support newly qualified practitioners and one that includes specific preparation for the role is proposed.

Newly hired nurses' and physicians' perceptions of the comprehensive health care orientation process: a pilot study

AIM

To examine newly hired nurses' and physicians' perceptions of their orientation process in two Finnish hospitals, and to explore correlations between the background variables and the four aspects of a comprehensive orientation process.

BACKGROUND

Internationally, health care organisations are being challenged to recruit and retain a competent workforce. Although health care orientation programmes increase retention and provide safe and quality care, studies examining it are limited.

METHOD

A cross-sectional, descriptive questionnaire survey of registered nurses (n = 145) and physicians (n = 37) working in two specialised hospital settings was conducted in 2009-2010.

RESULT

Nurses' and physicians' perceptions regarding the orientation process ranged from low to moderate. The results showed that 'appointed preceptor', 'duration of orientation' and 'profession' correlated positively and significantly with a comprehensive orientation process.

CONCLUSION

The orientation process needs to be updated constantly and refined by evaluation data. In addition, incentives and effective support from the hospital organisation must be considered in order to perform the orientation process in a more comprehensive manner.

IMPLICATIONS FOR NURSING MANAGEMENT

The results indicate that investment is needed to improve the orientation process in health care. Health care managers are in a crucial position to support the orientation process in practice and value it as a retention strategy.