New graduate nurse practice readiness: perspectives on the context shaping our understanding and expectations

Echoes of silence

Communication is an integral part of nursing practice-with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the 'other', language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing silence to speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly.

The effect of work readiness on work well-being for newly graduated nurses: The mediating role of emotional labor and psychological capital

OBJECTIVE

To investigate the relationship between work readiness and work well-being for newly graduated nurses and the mediating role of emotional labor and psychological capital in this relationship.

METHODS

A cross-sectional survey was conducted in mainland China. A total of 478 newly graduated nurses completed the Work Readiness Scale, Emotional Labour Scale, Psychological Capital Questionnaire, and Work Well-being Scale. Descriptive statistical methods, Pearson correlation analysis, and a structural equation model were used to analyze the available data.

RESULTS

Newly graduated nurses' work readiness was significantly positively correlated with work well-being (r = 0.21, p < 0.01), deep acting (r = 0.11, p < 0.05), and psychological capital (r = 0.18, p < 0.01). Emotional labor and psychological capital partially mediated the relationship between work readiness and work well-being. Additionally, emotional labor and psychological capital had a chain-mediating effect on the association.

CONCLUSIONS AND CLINICAL RELEVANCE

Work readiness not only affects newly graduated nurses' work well-being directly but also indirectly through emotional labor and psychological capital. These results provide theoretical support and guidance for the study and improvement of newly graduated nurses' work well-being and emphasize the importance of intervention measures to improve work readiness and psychological capital and the adoption of deep-acting emotional-labor strategies.

A Healthcare-Academic Practice Partnership Program to Promote Student Nurse Readiness for Work

Highly skilled new graduate nurses must be better prepared to face the clinical and professional challenges in today's healthcare environment. Compounding these challenges are the growing resignations of clinical faculty and experienced clinical nurses. Innovative programs are needed to bridge the knowledge-practice gap with opportunities to create pipelines to aid the future nursing workforce. A multihospital health system partnered with a local college of nursing to develop a Nursing Student Pipeline Program, which allows nursing students to perform select nursing tasks as employees of the health system. Fifty-six students have been hired to participate in the pilot program. Of the students eligible for hire and who completed the program, 24 are current employees with the healthcare system. Students, preceptors, and managers report the benefits of this program, including that participating in the program supports increasing readiness for practice upon graduation.

Determining Self-Efficacy of Nurses Who Graduated From Distance Education Because of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

BACKGROUND

The current literature states that distance education has caused a lack of professional skills, regression of existing professional skills (Kaya & Akin Isik, 2021; Kürtüncü & Kurt, 2020), a lack of self-confidence, and feelings of inadequacy among nursing students (George et al., 2020). The current study examined the professional self-efficacy of nurses who graduated from distance education because of the coronavirus disease 2019 pandemic.

METHOD

This multicenter cross-sectional study was conducted between November 2020 and June 2022 with 164 nurses who graduated from distance education in 2020-2021 from three faculties of health sciences.

RESULTS

Professional self-efficacy of the nurses was found to be above average. Male nurses and nurses who believed distance education had a negative impact on their professional skills had significantly higher professional self-efficacy. Some nurses reported that their professional theoretical knowledge was insufficient and defined the effect of distance education on their professional skills as relatively negative.

CONCLUSION

Most of the nurses expressed that distance education had a negative effect on their professional self-efficacy and working life. [J Contin Educ Nurs. 2023;54(10):480-488.].

The approaches and motivations to learning of student nurses: a phenomenological study

This research study was undertaken to elicit a group of final-year student nurses' perceptions of their motivations and approaches to learning, and the implications of their views. It is important to explore this subject because students' motivations and approaches to learning can potentially impact patient care. This study was part of a larger research project. The sample consisted of 18 final-year student nurses at a large UK university. Students completed semi-structured interviews that used a qualitative constructivist approach to explore their educational experience. Students described what motivated them to learn, and how they approached their learning because of their understanding of which subjects they believed were and were not important. Students felt that clinical skills were the most important subjects, and topics such as health promotion, law and ethics, were less important and therefore they approached these subjects in a superficial way, learning just enough to pass their course. Clinical skills were perceived as more useful because they would be used directly in clinical practice. The findings of this study are significant to inform nurse educators as they plan curricula and provide an insight into what may potentially adversely affect patient care when students become registered nurses.

Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review

OBJECTIVE

The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice.

INTRODUCTION

Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning.

INCLUSION CRITERIA

Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion.

METHODS

Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary.

RESULTS

The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review.

CONCLUSIONS

The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.

New Graduate Nurses Navigating Entry to Practice in the Covid-19 Pandemic

BACKGROUND

The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic.

PURPOSE

To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession.

METHODS

Thorne's interpretive description method was utilized.

FINDINGS

All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: 'Virtual Didn't Cut It,' 'Go Where You Know,' 'Picking Up the Pieces,' and 'Learning When to Say No and Let Go.' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession.

CONCLUSIONS

Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.

Validating an Instrument for Measuring Newly Graduated Nurses' Adaptation

A long-established approach, Confirmatory Factor Analysis (CFA) is used to validate measurement models of latent constructs. Employing CFA can be useful for assessing the validity and reliability of such models. The study adapted previous instruments and modified them to suit the current setting. The new measurement model is termed NENA-q. Exploratory factor analysis (EFA) revealed the instruments of the NENA-q model formed a construct of the second order with four dimensions, namely organizational contribution (OC), academic institution contribution (AIC), personality traits (PT), and newly employed nurses' adaptation (NENA). Researchers administered the questionnaires to a sample of 496 newly employed nurses working in hospitals under the Ministry of Health (MOH) for the confirmation of the extracted dimensions. The study performed a two-step CFA procedure to validate NENA-q since the model involves higher-order constructs. The first step was individual CFA, while the second step was pooled CFA. The validation procedure through confirmatory factor analysis (CFA) found the model achieved the threshold of construct validity through fitness index assessment. The model also achieved convergent validity when all average variance extracted (AVE) exceeded the threshold value of greater than 0.5. The assessment of the composite reliability (CR) value indicates all CR values exceeded the threshold value of 0.6, which indicates the construct achieved composite reliability. Overall, the NENA-q model consisting of the OC construct, AIC construct, PT construct, and NENA construct for CFA has met the fitness indexes and passed the measurements of the AVE, CR, and normality test. Once the measurement models have been validated through CFA procedure, the researcher can assemble these constructs into structural model and estimate the required parameter through structural equation modelling (SEM) procedure.

Graduate nurses' capability upon entering the workforce: An integrative review

OBJECTIVES

To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates.

DESIGN

Integrative review.

DATA SOURCES

Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases.

REVIEW METHODS

Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis.

RESULTS

Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge (knowing) along with practical knowledge (doing). They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates.

CONCLUSIONS

A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

Explaining Novice Nurses’ Experience of Weak Professional Confidence: A Qualitative Study

Introduction

The majority of newly graduated nurses are not prepared to work at the bedside; therefore, they may not have the appropriate self-confidence.

Objective(s)

The present qualitative study aimed to explain the novice nurses’ experience of weak professional confidence.

Design

This qualitative study was performed using a content analysis method.

Methods

Content analysis was utilized to identify themes from interview transcripts. They were included in the study by purposeful sampling. Participants were interviewed through face-to-face and unstructured interviews. All data were recorded, transcribed, and analyzed based on the Graneheim and Lundman method.

Results

Thirteen nurses participated in interviews. After data collection, all interviews were implemented and reviewed and the categories and subcategories were extracted. Three main categories containing turbulence in working life, unpleasant interactions, and lack of knowledge were extracted.

Conclusion

According to the study findings, most novice nurses experienced turbulence in their working life, unpleasant interactions, and a lack of knowledge that affected their self-confidence. Therefore, educational and support programs are suggested to improve novice nurses’ professional confidence.

Relevance to Clinical Practice

According to the results of the study, the lack of self-confidence in novice nurses reduces the quality of care. Therefore, taking into account the experiences of the participants, nursing education managers should plan in such a way as to improve the self-confidence of the graduates. In addition, novice nurses need to be supported by their managers and colleagues to develop their professional confidence to provide more effective care.

Work readiness of newly graduated nurses transitioning to practice in Saudi Arabia: A cross-sectional study

AIMS

To explore work readiness among newly graduated nurses transitioning to practice in Saudi Arabia.

BACKGROUND

Many challenges encounter newly graduated nurses when transitioning to practice. Higher work readiness has been associated with smooth transitioning to practice. However, little is known about work readiness among newly graduated nurses in Saudi Arabia.

METHODS

Cross-sectional convenience sample of 174 participants.

RESULTS

The mean score in work readiness was 338.8 (SD = 69.6). Weekly working hours correlated with organizational acumen (r = 0.208, p ≤ 0.01), social intelligence (r = 0. 217, p ≤ 0.01), work competence (r = 0.173, p ≤ 0.05) and the number of weeks since the start of internship training (r = 0.180, p ≤ 0.05). There were significant mean differences in a) personal work characteristics based on the country (t = 5.582, p < 0.001) and university from which they graduated (f = 15.618, p < 0.001); b) organizational acumen based on having a second job (t = -2.18, p = 0.03), university from which they graduated (f = 1.837, p = 0.002) and whether the hospital was the first-choice preference (t = - 2.837, p = 0.005) and nursing was the first choice of study (t = -2.879, p = 0.005); and c) work competence based on the university from which they graduated (f = 5.267, p = 0.006).

CONCLUSIONS

The findings showed the work readiness of newly graduated nurses in Saudi Arabia's context.

IMPLICATIONS FOR NURSING MANAGEMENT

Findings have important implications for nurse managers to better design and implement a transition to practice programs for newly graduated nurses to improve their preparedness in their nursing careers.

A pilot study on the use of the nominal group technique to refine core pharmacy roles and to determine what competencies may be missing from pharmacy education

INTRODUCTION

To describe the use of the nominal group technique (NGT) to refine pharmacy core roles and to compare these roles with current pharmacy outcomes and other literature to highlight potential deficiencies.

METHODS

The NGT process was used for this proposal review. The process was conducted in four key stages: silent generation, round-robin, clarification, and voting. A convenience sampling of five pharmacy faculty and administrators that have researched the areas of practice-readiness and pharmacy competencies formed the panel of participants for the NGT process.

RESULTS

Study findings offer seven core roles that define pharmacists' scope of practice: knowledge, patient care skills, professional, scholar, system-based practice/manager, collaborator, and advocate/health promoter. Development of these core roles revealed several missing pharmacy competencies or ones only covered in optional learning objectives: conflict management, professional advocacy, scholarship, empathy, personal health, transitions of care, health outcomes, quality improvement, and health insurance.

CONCLUSIONS

The development of pharmacy roles is one way to ensure students are adequately prepared for pharmacy practice following graduation. Mapping of competencies to core professional roles would allow schools/colleges of pharmacy to have one cohesive document to guide pedagogical and assessment practice. More research and consensus building will be needed before these core roles could be disseminated more broadly.

Where Do We Go From Here?

The COVID-19 pandemic has impacted nurses transitioning to practice in a variety of ways over the past 2 years. Analysis from the Versant Database comparing new graduate nurses (NGNs) from 2018–2021 revealed a widened practice gap for NGNs in these specialty areas of practice: critical care, perinatal, and emergency. Additionally, NGNs achieved 100% competency validation sooner in 2020–2021. The analysis also revealed greater diversity of NGNs who participated in a transition to practice program in 2020–2021. Based on these findings, this article proposes recommendations for nurse leaders to consider as NGNs transition into the workforce.

International nursing students’ perceptions and experiences of transition to the nursing workforce: - a cross-sectional survey

OBJECTIVE

To investigate international nursing students' perceptions about their preparedness and experiences of transition from the educational settings to the host country's nursing workforce.

BACKGROUND

Transition from a student to a registered nurse is a challenging phase for undergraduate nursing students. Undergraduate nursing students have reported concerns about their clinical preparedness and felt inadequately prepared as new graduates. One under-researched area is international nursing students' preparedness and experiences of transition from their undergraduate nursing program to the host country's nursing workforce.

DESIGN

A descriptive cross-sectional study.

SETTING

Online survey active from 26 October 2020-31 January 2021 in Australia.

PARTICIPANTS

110 eligible international nursing students (Mean age = 25.10 ± 3.32; 57.8% female) in the final year of their undergraduate nursing program Australian universities took part in the survey in 2020.

METHODS

The survey used the Casey-Fink Readiness for Practice Survey as well as newly added questions to measure transition preparedness, clinical preparedness, facilitators and barriers that may affect transition and the impact of Coronavirus disease of 2019 on transition. Both descriptive and inferential statistics were used for data analysis.

RESULTS

Over 90% of the respondents planned to transition to the Australian nursing workforce, with over 50% feeling prepared to transition as registered nurses. However, over 50% of the respondents did not feel ready to find nursing employment in Australia. When assessing clinical preparedness, participants reported their discomfort and lack of confidence in dealing with dying patients, delegating tasks to nursing assistants and communicating and interacting with physicians and interdisciplinary team members in the clinical area. They also reported clinical simulation activities helpful in clinical preparation, being comfortable in taking actions to solve problems and being confident in identifying actual or potential safety risks for patients. The major barriers for transition included temporary visa status, financial challenges, duration of clinical placements during the nursing program, inability to comprehend local colloquialism and knowledge of the Australian healthcare system. The main facilitators were clinical simulation experiences, the ability to speak languages other than English and interactions with people from diverse cultures.

CONCLUSIONS

International nursing students had unique challenges related to their temporary visa status, knowledge of the Australian healthcare system and comprehension of colloquialism. Clinical simulation experiences, the ability to interact with diverse cultures and speak different languages contributed positively to their transition preparedness. They expressed their desire to have extended clinical placements in more acute care settings to improve their clinical experiences.

Radical transformation: Embracing constructivism and pedagogy for an innovative nursing curriculum

To effectively navigate today's complex and rapidly changing health care environments, nurses require a high level of knowledge, sound psychomotor skills, diverse thinking and reasoning abilities, and a strong professional identity. The evidence showed that programs that offer students focused clinical practice experiences and offer students opportunities to 'think like a nurse' enable them to become sound practitioners. Faculty and staff at one mid-sized research-intensive university in Western Canada, engaged in an iterative process of rethinking the theoretical and pedagogical underpinnings of a BSN curriculum for educating nurses for the complexity of today's practice. Constructivist learning theory was chosen as the main underpinning of the revised curriculum. Furthermore, transformational learning theory guided the selection of several pedagogical approaches utilized throughout the program with the goal of inviting critical reflection and encouraging the development of competent, compassionate, ethical, and professional nurses. Additionally, we employed an innovative approach to clinical practicums where the process of learning is both integrated and intentional, and students are mentored to use prior knowledge in their decisions and clinical reasoning.

Proceed With Caution: Integrating Newly Graduated Nurses Into an Emergency Department

Virtually, no published research is available on the relationship between employing newly graduated nurses (NGNs) in the emergency department (ED) and the advancing of nursing practice and the optimization of patient care outcomes. Traditionally, nurses hired into these practice areas have required advanced skills in clinical assessment and experience with a variety of situations that were assumed to offer them a framework by which they could recognize and respond to potentially life-threatening changes in a patient's status. This qualitative study explored the issues of integrating NGNs into the ED. Findings clearly established the challenges to integrating NGNs into this practice context. The intersection of variables included a low level of clinical predictability accompanied by high acuity; an increased level of practitioner autonomy combined with high levels of risk when applying decision making to patient outcomes; and the potential for devolution of professional identity in the face of highly intense, morally conflicted, and socially nuanced care situations.

The Mediating Effects of Nursing Professional Commitment on the Relationship between Social Support, Resilience, and Intention to Stay among Newly Graduated Male Nurses: A Cross-Sectional Questionnaire Survey

The current shortage of nurses is an important global issue. Most male nurses leave nursing within four years of starting their nursing career. It is crucial to understand the influencing factors on newly graduated male nurses staying in nursing. Previous studies on intentions to stay as nurses were seldom based on theory and failed to consider the differences between genders. Based on the Job Demands-Resources (JD-R) model, this study tested the model that social support, resilience, and nursing professional commitment influence the intention to stay and the mediating effect of nursing professional commitment in the above relationship. This cross-sectional study adopted purposive and snowball sampling methods. Data were collected using online questionnaire, and 272 newly graduated male nurses completed it. The hypothetical model had a good fit with the data. Nursing professional commitment had a complete mediating effect between social support and intention to stay and between resilience and intention to stay. Nursing professional commitment was highly positively correlated to intention to stay. It is suggested that future research and practice should enhance male nurses’ professional commitment to increase their intention to stay. The findings can serve as reference for developing newly graduated male nurse retention programs.

The Future Capacity of the Nursing Workforce: COVID-19 Pandemic's Impacts on New Nurses and Nursing Students Toward the Profession

Supplemental digital content is available in the text.

Background

Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety.

Purpose

The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care.

Methods

New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation.

Results

Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing.

Conclusion

Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.

Interventions to support graduate nurse transition to practice and associated outcomes: A systematic review

OBJECTIVE

The aim of this mixed methods systematic review was to: i) document the interventions that support and facilitate graduate nurse transition from university to practice in a diversity of healthcare settings and ii) to identify outcomes from graduate nurse transition interventions for the graduate, patient or client, and health service.

DESIGN

This mixed methods systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria.

DATA SOURCES

Primary research studies located in Medline, EmBase, CINAHL, Prospero, Cochrane Library, PsycInfo, and Web of Science (Social Science Citation Index). All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria.

REVIEW METHODS

Using a comprehensive search strategy, retrieved articles were screened by two reviewers at the title, abstract, and full-text stage. Reviewer disagreements were discussed until consensus was achieved. The well-validated Mixed-Methods Appraisal Tool was used to assess quality of the quantitative, qualitative, and mixed methods studies.

RESULTS

A total of 130 studies were included as the review dataset. There was a myriad of terms used to describe transition interventions, and programme length and settings varied. The content of transition interventions was not well defined, and there was a lack of studies outside acute hospital settings. Data collection methods varied widely. The majority of authors reported outcomes for the graduate or the graduate and service, with only one reporting outcomes for the patient or client. There was a significant variation in quality across the studies.

CONCLUSIONS

This review addresses a significant gap in the literature by documenting transition interventions in a diversity of health settings and outcomes from these interventions. Interest in transition to practice continues to rise, but there is an urgent need to conduct well designed, robust, and larger-scale studies at the national and transnational levels.

Senior BSN students' confidence, comfort, and perception of readiness for clinical practice: the impacts of COVID-19

OBJECTIVES

The Coronavirus Disease 2019 (COVID-19) has impacted overall nursing education program requirements, classroom delivery of theory hours, as well as clinical and laboratory learning opportunities for students. The aims of this study were to explore the impacts of COVID 19 on the students' perceptions of readiness for practice and their preparation for the NCLEX exam and initial clinical practice.

METHODS

A cross-sectional descriptive design was used to investigate the impact of COVID-19 on senior BSN students' preparation for NCLEX and future careers. The Casey-Fink Readiness for Practice Survey was used to investigate the perceptions of the BSN students' clinical confidence and readiness for practice.

RESULTS

Students reported substantial impacts of COVID-19 on their clinical experiences, their ability to practice skills and procedures, their preparations for NCLEX exam, and their nursing career. The most significant confidence concerns noted from this study seemed to center on handling multiple patient assignments, calling the physician, responding to a change in patient condition, and treating a dying patient.

CONCLUSIONS

Healthcare experts expect that the impact of COVID-19 may last until 2022. More research is needed to understand the impact of COVID-19 on nursing education and transition to nursing practice. While clinical confidence and readiness for practice are essential topics, more research is needed to investigate the psychological and physiological impacts of COVID-19 on nurses, nursing students, nursing preceptors, and faculty members.

The defining characteristics of newly graduated nurses - A Delphi study

Despite processes designed to ensure that graduates of accredited nursing programs possess the necessary skills and knowledge to enter the workforce, a gap remains between graduate capabilities and industry expectations of work-readiness. This study aims to identify the defining characteristics of work-ready graduate nurses from the perspective of a purposive sample of new graduates, employers and academics utilising a three-round Delphi design and to compare the findings. In Round One participants provided free-text descriptors of graduate attributes, core knowledge and skills. In Rounds Two and Three participants prioritised categorised results from Round One and added free-text responses. Data from these rounds were not aggregated. In Round One, 14 academics, 20 clinicians and 12 graduates provided responses. In Round Two we received 10, 12 and 5 responses respectively and in Round Three 9, 8 and 4 responses respectively. The final round identified 19 characteristics and attributes, 10 knowledge areas and 11 skills for work-ready graduate nurses. This study identified that graduates should be safe practitioners, with professional behaviours, an understanding of anatomy and physiology, pathophysiology of disease, and medication safety, with good patient assessment and communication skills. Time management and prioritisation skills that graduates expect of themselves, develop with consolidation of practice.

Relationship between Personal Values, Work Experience and Nursing Competencies among Cancer Care Nurses in Malaysia

Oncology nurses are an essential component of cancer care teams. Nurses play a vital role in ensuring that cancer patients comply with their cancer treatment. In the cancer care nursing context, competency is not merely being skilled, but also implies the characteristic of being able to perform effectively. In addition to the need for competence, nursing is a discipline rich in values including human dignity, caring, humanity, and respect for personal privacy. Research from a variety of disciplines indicates that values often influence human behaviour in professional and work settings. It is often believed, therefore, that nurse' values and work experience influence and contribute to their work performance. Few studies have attempted to examine these relationships, particularly in the context of cancer care nursing. The purpose of this study was to determine the relationship between personal values, work experience and competency among cancer care nurses in Malaysia. Quantitative surveys were used to collect the data. A total of 845 cancer care nurses from 38 public hospitals in Peninsular Malaysia participated in the study. Descriptive statistics and Pearson Product-Moment Correlations were used to analyse the data. The findings revealed positive and significant relationships between personal values and competency (r = 0.59, p < 0.01) and work experience and competency (r = 0.11, p < 0.047). The findings support the assertion that Malaysian nurses' values and work experience are related to performance-related competency.
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The effectiveness of a Malaysian House Officer (HO) preparatory course for medical graduates on self-perceived confidence and readiness: A quasi-experimental study

Introduction

House Officer (HO) Preparatory Courses in Malaysia are designed to prepare medical graduates to work as a HO. The courses are designed to address the issues related to lack of confidence and readiness to work, which could lead to stress and HO dropping out of work. The modules focus on how to prepare medical graduates into the real-life working scenario. Hence, we determined the effectiveness of a HO Preparatory Course on the level of confidence and readiness to work among medical graduates.

Methodology

A quasi-experimental study was conducted at three time-points (pre-intervention, post-intervention and one-month after working as a HO) on the level of confidence and readiness of medical graduates. The intervention was the Medicorp module, which included information and training needed for the HO such as common clinical cases in the wards, case referrals, experience sharing and hands on clinical training. We recruited eligible participants undergoing the course between April–November 2018. The adapted IMU Student Competency Survey was used to measure the confidence and readiness levels, which were scored from a Likert scale of 1–5. The higher score indicated higher levels of confidence or readiness.

Results

A total of 239 participants were recruited at baseline (90% response rate). They were mostly female (77.8%), Malays (79.1%), single (90.0%), graduated overseas (73.6%), in 2018 (65.3%). The mean (SE) confidence scores significantly increased from 2.18 (1.00) pre-course to 3.50 (0.75) immediately after course and 3.79 (0.92) after one-month of work (p <0.001, η2 = 0.710). The mean (SE) readiness scores at pre-course, immediately and one-month post work were 2.36 (1.03), 3.46(0.78) and 3.70(0.90), respectively (p< 0.001, η2 = 0.612).

Conclusion

The HO Preparatory Course module was effective in increasing levels of confidence and readiness for medical graduates, most of whom are overseas graduates; namely Egypt, Russia and Indonesia.

Competence perceptions of veterinary nursing students and registered veterinary nurses in Ireland: a mixed methods explanatory study

Background

Veterinary regulators require veterinary nursing students to demonstrate clinical competence prior to registration and practice as a veterinary nurse. However, in common with other medical professions, there is no one broadly accepted definition of competence. Studies in nursing have revealed that practicing nurses may view newly qualified colleagues as lacking competence, leading to disillusionment with nursing training programmes. Similar studies are lacking in veterinary nursing, despite the profession having recently undergone a similar transition from workplace-based training to undergraduate education.

Methods

A mixed methods explanatory study surveyed 66 Irish registered veterinary nurses and 31 first year veterinary nursing students at two Irish third level institutions to obtain their views on what constitutes veterinary nursing competence and when veterinary nurses develop it. The surveys were followed by student focus groups and semi-structured one-on-one interviews with registered veterinary nurses. Content analysis was employed to analyse the surveys, while the focus groups and interview transcripts underwent thematic analysis.

Results

Students perceived competence primarily as the ability to provide patient care, and they expected it to develop close to the time of graduation. RVNs held a broader definition of competence, incorporating leadership skills and confidence as well as patient care provision. RVNs expected it to take approximately two years of workplace-based experience post-graduation for a veterinary nurse to develop competence. In addition, RVNs recognised that anxiety felt by many newly qualified veterinary nurses during this period could be attenuated by mentorship from more experienced colleagues.

Conclusions

Irish RVNs and veterinary nursing students perceive competence differently, similar to previous findings from the nursing profession. Educators and regulators should provide explicit descriptions of terms such as ‘competence’ to avoid confusion and possible disillusionment amongst veterinary nursing stakeholders.

'Thinking like a nurse'. Changing the culture of nursing students' clinical learning: Implementing collaborative learning in practice

This article reports a study evaluating the implementation of Collaborative Learning in Practice models at a university School of Nursing and Midwifery with practice partners across the South West of England. We conducted four focus group interviews with 40 students with experience of Collaborative Learning in Practice placements, and two focus groups with eight clinical practice staff with responsibility for implementing and supporting such models in their areas. Data were transcribed and analysed using the Framework Method. Key themes were 'Real time' Practice of Collaborative Learning Implementation, Collaborative Learning as Preparation for Registrant Practice, and the Student/Mentor Relationship. We conclude that Collaborative Learning in Practice utilising models of coaching and peer support, offers benefits to students who are exposed to the reality of nursing practice from the beginning of their placement experiences, enabling them greater responsibility and peer support than under normal mentoring arrangements. Furthermore, there are benefits to the registrants because the burdens of supervising students are spread more widely. This is timely given the review of Nursing and Midwifery Council standards for programmes and student support and the need to increase placement capacity as a response to global nursing shortages.

Development and initial validation of an instrument to measure novice nurses' perceived ability to provide care in acute situations - PCAS

BACKGROUND

Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses' perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations.

METHOD

Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group.Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct.

RESULT

The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach's alfa 0.90 and ordinal alpha 0.92.

CONCLUSIONS

The PCAS scale has proven to have acceptable validity. The factors," confidence in provision of care", "communication" and "patient perspective" are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.

From Suffering to Indifference: Reaction of Novice Nurses to Ethical Challenges in First Year of Clinical Practice

BACKGROUND

The first year of clinical practice is one of the most important steps in nursing career life. Although, studies have been conducted on ethical issues in nurses, however, few studies have been conducted on the responses of novice nurses to ethical issues. The purpose of this study was to explore the responses of novice nurses to ethical challenges in the first year of clinical practice.

MATERIALS AND METHODS

This study is a qualitative study with content analysis approach was conducted with financial support of Arak University of Medical Sciences. In this study, about 11 novice nurses selected using purposive sampling from educational hospitals affiliated to Arak University of Medical Sciences. Data were collected by semi-structured interviews. The duration of the interviews was 30-110 minutes. In order to analyze the data, inductive content analysis was used.

RESULTS

Data analysis revealed two important, and different responses over time in novice nurses. So that at the beginning of practice, the reaction to ethical challenges was "suffering" and after a few months it became "indifference".

CONCLUSIONS

This study showed that the response of novice nurses to ethical challenges in the first year of clinical practice was a transition from suffering to indifference. These findings can be used in nursing education, research and practice. Further research is recommended in this regard.

Clinical educators' attitudes towards the use of technology in the clinical teaching environment. A mixed methods study

Introduction

In healthcare, there is ongoing flux in expectations for students and practitioners. Establishing integrated systems of monitoring and evidencing students’ development is imperative. With current trends towards the use of technology in tertiary education, online learning environments (OLEs) could constitute more effective evidencing of student progress in the clinical environment. However, there is little research exploring clinical educators' experiences with implementing technology in clinical education.

The research aimed to:

Examine clinical educators’ attitudes towards technology and its use in clinical education.

Explore clinical educators’ experiences of implementing technologies in a clinical environment.

Methods

A mixed methods approach was taken to explore the aims. A previously validated technology attitude survey (TAS) was used with slight modifications, as well as open‐ended qualitative responses. These explored clinical educators’ experiences of the implementation of one specific OLE (PebblePad™) in their clinical environments. The survey was sent to clinical educators involved in the supervision of Medical Imaging students on clinical placement.

Results

Clinical educators play pivotal roles in students’ professional development and, given current trends in tertiary education, are under increasing pressure to utilise OLEs. This poses particular challenges in clinical environments. Irrespective of the challenges, successful implementation of technology in any environment is dependent on the attitudes of the users.

Conclusions

Clinical environments have specific challenges when implementing technology such as access to computers and time constraints on practitioners. Even with positive attitudes towards technology, a change in pedagogical outlook when using technology in clinical teaching is necessary.

Final year pre-registration student nurses perceptions of which taught theoretical knowledge is important for practice

This research illuminates the perceptions of eighteen final year undergraduate pre-registration student nurses, to understand what theoretical knowledge was perceived to be useful during their pre-registration nursing education, and what was not. The research adopted a qualitative phenomenological approach, and utilised a sample size of eighteen final year student nurses as the data source. The data collection method consisted of semi-structured interviews and the study took place at a Higher Education Institution within the North West of England approved to provide pre-registration nurse education. Participants provided their data during their final year of their undergraduate pre-registration nursing programme, via semi-structured, digitally recorded interviews, which were transcribed verbatim. The transcribed interviews were then analysed using Interpretive Phenomenological Analysis. The findings generated three themes, these were; important knowledge to learn for everyday practice, irrelevant for my future role, and, can we have some more? Findings demonstrate what aspects of the taught curriculum student nurses perceive to be of use to their practice, and why they perceive this to be the case. This affects how student nurses approach their learning during their nursing education. In addition it was clear what participants perceived was not useful for their practice and why this was the case. Additionally, participants offered suggestions of what they would also like adding to their curriculum, and provided insights for what they would like adding to the curriculum, which can be used for enhancing this. This is useful when developing future curricula to understand which aspects student nurses learn in a deep and superficial way. This can provide a useful insight for to ensure that patient care is not compromised.

Factors developing nursing students and novice nurses' ability to provide care in acute situations

Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses' ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.

Expected clinical competence from midwifery graduates during community service placement in Limpopo province, South Africa

Background

Community service nurses are placed in a hospital within the first year after qualifying to obtain clinical experience under the supervision of experienced professional nurses. When placed in clinical environments, new midwifery graduates are expected to be job ready, demonstrate competence in the provision of evidence-based care, practise independently and assume accountability and responsibility for their own actions.

Aim

The study aimed at exploring the expectations of experienced midwives of clinical competence of newly graduated midwives during transition.

Setting

The study was conducted at the training hospitals of the five districts in Limpopo province.

Method

The researcher used a qualitative approach which is explorative and descriptive in nature. The population comprised all the professional midwives with experience of 5 years and above working at the selected hospitals in Vhembe, Mopani, Capricorn, Waterberg and Sekhukhune districts of Limpopo province, South Africa. From each selected hospital, five experienced midwives were selected using non-probability, purposive sampling method. An in-depth individual face-to-face interview was used to collect data from the participants, until saturation was reached. The open-coding, Tesch’s eight-step process was used to analyse data.

Results

Results revealed that newly graduated midwives failed to meet the perceived expectations by experienced midwives; this was reflected in sub-themes: limited sense of independence, limited participation in task sharing and commitment and competence versus incompetence to patient care.

Conclusion

The experienced midwives expected newly graduated midwives to function as professionals; unfortunately, they expressed disappointment as graduates did not meet their expectations. Newly graduated midwives lacked sense of independence, commitment to patient care and did not display ability in task sharing.

Influence of new hire transition workload on insomnia in nurses

AIMS

In this study, we investigated the relationship of the prevalence and incidence of insomnia with the new hire transition workload in nurses.

METHODS

This retrospective study used the clinical diagnosis data of the entire nursing population in Taiwan for 2005 to 2008, drawn from the National Health Insurance Research Database. Adjusted logistic regression and Cox regression models were used to separately analyse factors related to the prevalence and incidence of insomnia.

RESULTS

During this period, the prevalence of insomnia increased, whereas its incidence remained stable. After adjustment for demographic variables in the logistic regression models, the higher prevalence of insomnia was associated with a longer employment duration and a higher new hire ratio. In the Cox regression models, a higher incidence of insomnia was associated with a shorter employment duration and a higher new hire ratio. Nurses with a longer employment duration had a higher prevalence, but lower incidence, of insomnia. A higher new hire ratio was associated with a higher prevalence and incidence of insomnia.

CONCLUSION

To mitigate the risk of insomnia, we suggest that additional support should be provided to non-new nurses to assist them in the new hire transition.

Undergraduate nursing assistant employment in aged care has benefits for new graduates

AIMS

To determine how undergraduate assistant in nursing employment in aged care helps to prepare new graduates for clinical work as a Registered Nurse.

BACKGROUND

The amount and quality of clinical experience afforded by university programs has been the subject of constant debate in the nursing profession. New graduate nurses are often deemed inadequately prepared for clinical practice and so many nursing students seek employment as assistants in nursing whilst studying to increase their clinical experience.

DESIGN

This paper presents the first phase of a larger mixed-methods study to explore whether undergraduate assistant in nursing employment in aged care prepares new graduate nurses for the clinical work environment. The first phase involved the collection of quantitative data from a modified Preparation for Clinical Practice survey, which contained 50-scaled items relating to nursing practice.

METHODS

Ethics approval was obtained prior to commencing data collection. New graduate nurses who were previously employed as assistants in nursing in aged care and had at least 3 months' experience as a Registered Nurse, were invited to complete the survey. Social media and professional networks were used to distribute the survey between March 2015 - May 2016 and again in January 2017-February 2017. Purposeful and snowballing sampling methods using social media and nursing networks were used to collect survey responses. Data were analysed using principal components analysis.

RESULTS

110 completed surveys were returned. Principal components analysis revealed four underlying constructs (components) of undergraduate assistant in nursing employment in aged care. These were emotional literacy (component 1), clinical skills (component 2), managing complex patient care (component 3) and health promotion (component 4).

CONCLUSION

The four extracted components reflect the development of core nursing skills that transcend that of technical skills and includes the ability to situate oneself as a nurse in the care of an individual and in a healthcare team.

Psychometric evaluation of the Environmental Reality Shock-Related Issues and Concerns instrument for newly graduated nurses

BACKGROUND

Reality shock is a critical representation of the gap between nursing education and clinical practice and it is important to explore the level of reality shock among nurses. However, there is no relevant instrument to assess the level of reality shock in South Korea.

OBJECTIVES

The purpose of this is to determine the validity and reliability of the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument.

DESIGN

A cross-sectional study design was used in this study.

SETTINGS

The data collection was conducted in selected 15 hospitals in South Korea.

PARTICIPANTS

A convenience sample of 216 newly graduated nurses participated in the study.

METHODS

The Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument was developed through the forward-backward translation technique, and revision based on feedback from expert groups. The internal consistency reliability was assessed using Cronbach's alpha, and the construct validity was determined via exploratory and confirmatory factor analysis.

RESULTS

The Korean version of the Environmental Reality Shock-Related Issues and Concerns has reliable internal consistency (Cronbach's alpha=0.91). Exploratory factor analysis revealed five factors including job, relationships, expectations, private life, and performance, which explained 61.92% of variance. The factor loadings ranged from 0.451 to 0.832. The five-factor structure was validated by confirmatory factor analysis (RMR<0.05, CFI>0.9).

CONCLUSION

It was concluded that the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument has satisfactory construct validity and reliability to measure the reality shock of newly graduated nurses in South Korea.