New graduate nurses' experiences in their first year of practice

The impact of preceptorship on the newly qualified nurse and preceptors working in a critical care environment: An integrative literature review

BACKGROUND

Preceptorship has been found to be effective in supporting Newly Qualified Nurses (NQNs) during their transition into challenging environments, particularly in addressing issues related to confidence and anxiety. Effective preceptorship is an element of best practice and essential to support NQNs' transition into the critical care setting. However, the impact of preceptorship on NQNs and their preceptors in critical care units is yet to be completely understood.

AIM

To review the impact of preceptorship on NQNs and preceptors working in a critical care environment.

STUDY DESIGN

An integrative literature review of the literature. The review employed Whittemore and Knafl's (2005) five-stage integrative review approach.

METHODS

Three databases (MEDLINE, CINAHL and PsycINFO) were searched for papers published between January 2010 and May 2022. The PRISMA framework was used to guide the search and screening. Thematic analysis was used to extract, organize and analyse the data.

RESULTS

Nine studies were included in this review. Reflective thematic analysis revealed three themes, with four related subthemes. Preceptorship has an impact on the development of the NQNs and preceptors' 'nurturing' relationship. NQNs develop their knowledge, competence and confidence when experiencing supportive preceptorship. Meanwhile, preceptors experience a combination of increased workload and opportunities for learning and professional development as a result of preceptorship.

CONCLUSION

There is evidence of the impact of preceptorship on learning and professional development for both NQNs and preceptors, but this is a complex phenomenon and further research is required to understand this area more fully.

RELEVANCE TO CLINICAL PRACTICE

In nursing practice, it is well-established that Newly Qualified Nurses (NQNs) often face heightened levels of anxiety and a lack of confidence when embarking on their careers, particularly in the demanding and stressful environment of critical care units. This review holds particular significance in the realm of clinical practice as it delves into the pivotal role of preceptorship in nurturing the professional growth and development of NQNs within the challenging domain of critical care. Effective preceptorship, as an essential component of best practice, plays a pivotal role in aiding NQNs' transition into critical care settings.

The Turkish version of nursing practice readiness scale: Cross-cultural adaptation and psychometric evaluation

AIM

This study aims to adapt the "Nursing Practice Readiness Scale" to Turkish culture, and evaluate its psychometric properties.

BACKGROUND

New graduates' nursing practice readiness can impact their work adaptation and performance.

DESIGN

The research employed a methodological design.

METHODS

Data were collected between May and July 2022. The sample consisted of 436 newly graduated nurses. Content validity, construct validity and criterion validity were evaluated. Reliability was examined with adjusted item-total correlation, Cronbach's a coefficient, composite-reliability and split-half reliability.

RESULTS

The Turkish version of Nursing Practice Readiness Scale was found to have good content and criterion validity. As a result of confirmatory factor analysis, the original five-factor structure of the scale was also confirmed for the Turkish version. The scale's overall Cronbach's α coefficient was determined to be 0.96, with subscale coefficients ranging from 0.73 to 0.94. The composite reliability values of the subscales were found between 0.75 and 0.94. In split-half reliability, the correlation coefficient between half was 0.952, with a Spearman-Brown Coefficient (Unequal Length) of 0.976.

CONCLUSIONS

The Turkish version of Nursing Practice Readiness Scale is a valid and reliable measurement tool for evaluating the nursing practice readiness of newly graduated nurses.

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.

Intensive care as a specialty of choice for registered nurses: A descriptive phenomenological study

BACKGROUND

Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care.

AIM

To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit.

STUDY DESIGN

This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two).

FINDINGS

Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment.

CONCLUSIONS

This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.

Evaluating the Importance of Clinical Judgment in Entry-Level Nursing

BACKGROUND

This study investigated the extent to which clinical judgment is important in entry-level nursing practice.

METHOD

A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation.

RESULTS

The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance.

CONCLUSION

Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].

The first year of private practice - new graduate physiotherapists are highly engaged and satisfied but edging toward burnout

BACKGROUND

A greater understanding of physiotherapists' work-life during their first year of work in private practice, and whether their experiences are mediated by personal traits, may provide valuable information to support their transition and retention.

OBJECTIVES

Describe the first year of practice for graduate physiotherapists in terms of employee engagement, job satisfaction, performance, and burnout, and evaluate the relationship between these measures and personal traits (resilience, grit, mind-set).

DESIGN

One-year longitudinal mixed-methods study.

METHODS

Twenty new graduate physiotherapists completed questionnaires evaluating resilience, grit, and mind-set within 1-week of commencing employment. Engagement and job satisfaction were evaluated at 3, 6 and 12-months, and burnout evaluated at 12-months. Performance data (number of patients seen, revenue) were collected throughout the year. Individual semi-structured interviews were conducted at baseline, 3, 9 and 12-months.

RESULTS

Engagement and satisfaction were high at all time points. At 12-months, burnout was at a medium level. Resilience was positively associated with job satisfaction at 6 (ρ = 0.56, p = .019) and 12-months (ρ = 0.54, p = .027). Engagement (ρ = -0.57, p = .04) and job satisfaction (ρ = -0.56, p = .03) were negatively associated with burnout at 12-months. All participants remained passionate about their work although increasing administrative burden and patient complexity contributed to feelings of burnout.

CONCLUSIONS

Resilience was positively associated with job satisfaction suggesting those with capacity to 'bounce back' were more satisfied and engaged with their job. Although moderate levels of burnout were reported at 12-months, those with higher job satisfaction and employee engagement had lower levels of burnout. Participants proposed practical strategies to help mitigate burnout.

Midwifery students' experiences of their clinical internship placement during the COVID-19 pandemic in Ireland: A qualitative descriptive study

OBJECTIVE

To explore the impact of the COVID-19 global pandemic on midwifery students' experiences of clinical internship placement in the final year of their midwifery programme.

DESIGN

A qualitative descriptive study was conducted following ethical approval. Four online focus groups were facilitated.

SETTING AND PARTICIPANTS

To prepare for autonomous practice, BSc Midwifery students in the Republic of Ireland (RoI) undertake a 36-week internship in the final year of their programme. Midwifery students (n = 15), from one Higher Education Institute (HEI), who were undertaking internship across two clinical practice sites volunteered to participate in the study.

FINDINGS

Four overarching themes were identified: Fear and uncertainty of internship in the context of a pandemic, Consequences of COVID-19 within the clinical environment, Student supports, Opportunities and challenges during internship. Working within a health care environment dominated by the presence of COVID-19 had significant consequences for the students and their provision of care for women and families. Students were challenged with managing increased responsibility within the context of COVID-19 practice requirements and restrictions. Students balanced their need to progress to autonomous practice, whilst acknowledging their needs as learners. COVID-19 also brought unexpected benefits, which included enhancing students' ability to develop relationships with women in their care, and students described a sense of belonging within the midwifery team.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwifery students identified internship, during the COVID-19 pandemic as challenging and stressful. However, students also portrayed a sense of pride in their achievements. Support structures assisted students to cope during this period which included peer support, protective reflective time (PRT) in the HEI and support from clinical placement coordinators in midwifery (CPC-Midwifery) within clinical placements sites. It is essential that these support structures continue within midwifery educational programmes. Promoting peer support in a more formal support structure may need consideration. These support structures need to be protected and enhanced during unprecedented times, such as the COVID-19 pandemic.

New registered nurse and registered psychiatric nurse graduates' transition-to-practice amid the pandemic: An art-based grounded theory study

BACKGROUND

According to the Transition Shock theory, new Registered Nurses face formidable obstacles within their first year of practice. However, little is known about the experience of new Registered Psychiatric Nurses entering the workforce.

OBJECTIVES

The aim was to explore how new graduates from nursing and psychiatric nursing experience their transition into the workplace that included identifying mediating factors that assist or challenge these entry-level professionals within their transition.

DESIGN

Constructivist grounded theory methodology developed by Charmaz was utilized to explore the first-year transition period using art-based methods.

PARTICIPANTS AND SETTING

A total of 13 new graduates practicing as Registered Nurses and Registered Psychiatric Nurse in a western Canadian province were recruited to participate in the study. Three art-based workshops occurred at four, eight, and 12-months starting in the fall of 2020 through the Spring of 2021 during the novel coronavirus pandemic with subsequent member checks in the Spring of 2022.

METHODS

A total of 38 interview and focus group data were collected. Art-based activities included sand tray and figurine object exercises, collaging, reflective and thematic writing, as well as group concept mapping. Through co-creation of knowledge using Charmaz's methodology, participants selected the major themes throughout their first year of transition with guided researcher facilitation. Data were analyzed using the constant comparative method of analysis for each workshop drawing on the art creations, discussion, and narrative reflective writing pieces generated by participants.

RESULTS

Participants were in a basic psychosocial process of growing personal and professional self. Through co-construction of knowledge with the participants, three substantive interconnected categories were identified: (1) Being thrown into the fire; (2) Adjusting and adapting to the team environment; and (3) Nurturing self and others.

CONCLUSIONS

The findings revealed many recommendations for employers hiring new graduates and nursing education programs preparing graduates for the practice arena.

The implementation of Tanner's Clinical Judgment Model and the Indonesian version of the Lasater Clinical Judgment Rubric in the clinical setting

A critical component for nurses to provide safe and quality care with strong patient outcomes is clinical judgment. This study aimed to identify the difference in the clinical judgment score in newly graduated nurses by implementing Tanner's Clinical Judgment Model. This study followed an experimental design with a pretest-posttest and involved thirty-two newly graduated nurses from three private hospitals in Indonesia. The intervention group had a scheduled post-conference with their preceptors using Tanner's Clinical Judgment Model's guidelines with high-level, open-ended questions for two consecutive weeks. Independent samples t-test was used to compare pre-and post-test scores utilizing the valid and reliable Indonesia version of the Lasater Clinical Judgment Rubric. There was no significant difference between the pre-test results of the intervention and control groups, with a significance value of 0.647. The results indicated a significant difference in the mean clinical judgment scores between the intervention and control groups after two weeks of intervention, where the intervention group's scores were higher than the control group's with a significance value of <0.001 with a mean difference of 6.75 and CI of 95 % (4.18-9.31). Tanner's Clinical Judgment Model showed a significant impact in increasing clinical judgment scores. The Indonesia version of the Lasater Clinical Judgment Rubric is a valuable tool for assessing and evaluating the development of clinical judgment and provides detailed targeted areas needing improvement. Preceptors and nursing leaders in the clinical setting should continue to use this model and tools to assist newly graduated nurses in developing clinical judgment skills during their transition period.

Senior nurses' expectations and support of new graduate nurses' adjustment in hospitals: A qualitative descriptive study

Aim

This study aimed to identify senior nurses' expectations and support of new graduate nurses' adjustment to their work environment.

Background

New graduate nurses have difficulties in adjusting to their work environment because they are not well prepared for clinical nursing practice upon graduation. Hospitals support their adjustment to their work environment through residency/transition programs. Although such support exists, new graduate nurses are expected to learn the expected behavior and attitude themselves. Thus, identifying senior nurses' expectations and support of new graduate nurses' adjustment may facilitate smooth adjustment to the work environment.

Design

This was a qualitative descriptive study.

Methods

Fourteen nurses who teach new graduate nurses in Japanese hospitals were interviewed face-to-face individually. The data were analyzed using qualitative inductive content analysis, which was coded and sorted to identify categories.

Results

Regarding senior nurses' expectations of new graduate nurses' adjustment, six categories emerged: trying to fit in with people in their ward, behaving by following the unspoken rules of their ward, having attitudes compatible with learning, addressing their situations using their initiative, showing a willingness to learn, and obtaining necessary information by themselves. Senior nurses' support of new graduate nurses' adjustment consisted of four categories: watching over and speaking to them, trying to create a good working environment, encouraging them to have attitudes compatible with learning, and teaching them how to learn.

Conclusions

Senior nurses need to understand and express what they expect from new graduate nurses at the stage of hospital adjustment. If senior nurses understand their expectations for adjustment, they can help new graduate nurses effectively. Furthermore, understanding the expectations of senior nurses may facilitate new graduate nurses' adjustment. These findings may contribute to good working relationships between senior and new graduate nurses.

Taking or creating control: A qualitative study of uncertainty among novice nurses in ambulance care

INTRODUCTION

In emergency nursing situations, uncertainty may lead to delays, or block a decision which can have devastating consequences for a patient. The ambulance service is a complex clinical environment that often challenges the decision-making capabilities of the professionals, especially novice nurses. Novice nurses' uncertainty may also lead to unhealthy transitions and turnover. To increase the understanding of how uncertainty affects novice nurses, this study explores novice nurses' uncertainty during the first year of professional practice in the ambulance service.

METHOD

A qualitative descriptive design was applied using qualitative content analysis of thirteen individual face-to-face semi-structured deep interviews.

RESULT

From nine subcategories, three generic categories were derived: Reflections on contextual understanding, Strategies to create control, and Actions to take control. These were combined to form the main category Understanding what and dealing with how, while becoming a confident professional.

CONCLUSION

Uncertainty is exacerbated by situations that demand rapid decisions or actions. This is especially true of newcomers to a profession. Preparing novices through study programs and encouraging continuous reflection in professional practice may increase resilience and tolerance of uncertainty, as well as benefiting professional development.

Promoting patient safety using electronic medical records in nursing/midwifery undergraduate curricula: Discussion paper

This discussion paper highlights the importance of Australian nursing and midwifery students' lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness. Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student's skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program. In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety.

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.

New Nurses' Perceptions on Transition to Practice: A Thematic Analysis

BACKGROUND

New nurses' transition to the workforce is often described as challenging and stressful. Concerns over this transition to practice are well documented, with the hypothesis that transition experiences influence the retention of new nurses in the workforce and profession.

METHODS

In a cross-sectional survey (N = 217) to assess new nurse transition in the province of Ontario, Canada, an open-ended item was included to solicit specific examples of the transition experience. The comments underwent thematic analysis to identify the facilitators and barriers of transition to practice for new nurses.

RESULTS

Comments were provided by 196 respondents. Three facilitator themes (supportive teams; feeling accepted, confident, and prepared; new graduate guarantee) and four barrier themes (feeling unprepared; discouraging realities and unsupportive cultures; lacking confidence/feeling unsure; false hope) to new nurse transition emerged.

CONCLUSIONS

Concerns of nursing shortages are heightened in the current COVID-19 pandemic, reinforcing the priority of retaining new nurses in the workforce. The reported themes offer insight into the contribution of a supportive work environment to new nurses' transition. The recommendations focus on aspects of supportive environments and educational strategies, including final practicums, to assist nursing students' development of self-efficacy and preparation for the workplace.

New nurses' experience during a two year transition period to clinical practice: A phenomenological study

BACKGROUND

New nurses' clinical competency is a central concern across the world. The China Health and Planning Commission proposed an "Outline of transition programs for newly graduated nurses (try out)" to promote the new nurses' clinical competency within the first two years. Compared with the transition program in other countries, the one in China is longer. New nurses' experiences in their transition to practice were not fully explored in China. Their lived experience may inform the better transition program in China and other countries.

OBJECTIVE

To explore the experience of new nurses during the two-year transition period to clinical practice.

DESIGN

A descriptive phenomenological study.

METHODS

Face-to-face, semi-structured in-depth interviews were conducted in two teaching hospitals in China to interview 14 nurses within three months after the completion of transition. Data were analyzed using Colaizzi's seven-step data analysis method，which includes familiarization, identifying significant statements, formulating meanings, clustering themes, developing an exhaustive description, producing the fundamental structure, and seeking verification (1978). Tape-recording and observational notes were taken and typed word by word. Two researchers verified the verbatim transcripts.

RESULTS

Five categories and 15 theme clusters were identified: 1.

CHALLENGE

early-stage stress and anxiety; perceived change of mentality and self-reflection; 2.

RESPONSE

self-encouragement; self-compulsion, tolerance, adaptation; peer support and affirmation; 3. Growth: overall clinical competency improvement; perceived harvesting; nursing skills improvement; knowledge enhancement; 4.

REFLECTION

self-inadequacy; rotation benefits; the merits of different departments; lack sense of belonging; and 5. Expectation: desire to be treated equally; hope to have more opportunities.

CONCLUSIONS

The findings of our study suggested that support was most needed while the new nurses were facing challenges in the early stage to promote their sense of belonging. In addition, more systematic learning opportunities are needed to maximize learning for NGNs with different nursing degrees.

Novice nurses and factors that influence job adaptation after incorporation into the world of work

Abstract Objective To analyze the factors that influence the job adaptation of hospital nursing, during the transition period of graduates as a health workforce in their new stage. Method An exploratory, cross-sectional study, involving 100 graduate nurses as a workforce of hospital units. The collection was carried out with a questionnaire on the web platform in the period November 2020 - August 2021. The analysis was carried out using descriptive statistics. Results There was a predominance of women, single, aged between 23 and 32, licensed and operational, working between 19 months and 2 years. Regarding the factors, three most influential were identified, corresponding to: Autonomy; Psychological; Staff. Conclusions and implications for practice The adaptation of nursing staff in the hospital presents difficulties in the transition period; the internal factors of the professional, whether acquired through practices or developed during life, and the training of employers have influence. For improvement, it would be essential that the induction protocols guarantee the adaptation of the novice and that the employee training programs evaluate the effectiveness of the nursing staff in the hospital, until the achievement of the adaptation of nursing to the hospital.

Enfermeiros novatos e os fatores que influenciam a adaptação ao trabalho após a incorporação ao mundo laboral

Resumo Objetivo Analisar os fatores que influenciam a adaptação ao trabalho da enfermagem hospitalar durante o período de transição dos egressos como força de trabalho em saúde em sua nova etapa. Método Estudo exploratório, transversal, que envolveu 100 enfermeiros graduados como força de trabalho de unidades hospitalares. A coleta foi realizada com um questionário na plataforma web no período de novembro de 2020 a agosto de 2021. A análise foi realizada por meio de estatística descritiva. Resultados Houve predomínio de mulheres, solteiras, com idade entre 23 e 32 anos, licenciadas e operacionais, trabalhando entre 19 meses e 2 anos. Em relação aos fatores, foram identificados três mais influentes: Autonomia; Psicológico; Funcionários. Conclusões e implicações para a prática A adaptação da equipe de enfermagem no hospital apresenta dificuldades no período de transição; os fatores internos do profissional, sejam adquiridos por meio de práticas ou desenvolvidos ao longo da vida, e a formação dos empregadores influenciam. Para melhoria, seria fundamental que os protocolos de indução garantissem a adaptação do novato e que os programas de treinamento de funcionários avaliassem a efetividade da equipe de enfermagem no hospital, até a realização da adaptação da enfermagem ao hospital.

New Graduate Nurses' Experiences and Challenges during a One-Year Clinical Rotation Programme in the Volta Region of Ghana: Implications for Nursing Management and Nursing Workforce Retention

Background

To help improve the standards and quality of nursing practice, newly graduated nurses and midwives are required after passing the Nursing and Midwifery Council's Licensing Examination to undertake a one-year mandatory clinical rotation at health facilities before registration. However, there is a lack of scientific studies to explore new graduate nurses' experiences and challenges during the one-year mandatory clinical rotation programme.

Aim

This study is aimed at exploring newly qualified nurses' experiences and challenges during the one-year mandatory clinical rotation in health facilities in the Volta Region of Ghana.

Methods

This qualitative exploratory study used a combination of focus group discussions (FGDs) and individual interviews. Thirty (30) newly qualified nurses were selected from two secondary and one tertiary health facilities, where newly qualified nurses are posted for a clinical rotation programmes to participate in the study. A total of two focus group discussions (FGDs) were conducted, comprising five (5) members in each group. Moreover, twenty (20) newly qualified nurses were interviewed individually, and their data were added to what was obtained from the focus group discussions. This study adopted the thematic analysis approach to analyze the data.

Results

The results of this study showed that newly qualified nurses experienced the following during the one-year clinical rotation programme: acquisition of more knowledge and competencies to assume professional nursing roles; lack of knowledge of the objectives of the clinical rotation programme by hospital staff; experience of frustration during the clinical rotation programme; inadequate supervision and support; accommodation and financial challenges.

Conclusion

The study revealed important challenges experienced by new graduate nurses during the clinical rotation programme, including hospital staff's lack of knowledge regarding the objectives of the rotation programme, inadequate supervision and support, and accommodation and financial challenges. There is a need for the Nursing and Midwifery Council to develop guidelines for the one-year mandatory clinical rotation for newly graduated nurses and midwives to make the programme more effective.

Veterinary nursing in the United Kingdom: Identifying the factors that influence retention within the profession

The UK regulatory body for registered veterinary nurses (RVNs), the Royal College of Veterinary Surgeons (RCVS), maintains the professional register of RVNs. Every year, a proportion fail to re-join the register. This research aimed to identify the factors that predict retention and to make recommendations to inform the Royal College of Veterinary Surgeons as the regulator as well as both the veterinary nursing and veterinary professions. An analysis of the raw quantitative data generated by the 2014 and 2019 RCVS surveys of the veterinary nurse profession was undertaken using multivariable logistic regression analysis. First, bivariable associations were estimated using unadjusted odds ratios to explore whether there are any (unconditional) associations between each predictor and the outcome. Predictors that were significant unconditional predictors of intention to leave were then entered into a multivariable logistic regression, yielding adjusted odds ratios. Quantitative analysis found significant relationships between intention to leave and the following factors in both the 2014 and 2019 survey data: job satisfaction; believing that veterinary nursing offers good opportunities for career progression; satisfaction with employer support; and having a second job. The following factors were significant in 2014, but not in 2019: undertaking nurse clinics, feeling valued, and being respected by veterinary surgeons. The factors that influence the retention of registered veterinary nurses (RVNs) within the profession are multifactorial and individual. Nurses are responsible for ensuring that those they work with are aware of their skill set and that they themselves are accountable for utilisation of those skills. When veterinary nurses are supported by their employers, they are more likely to stay in the profession. Having a clearly defined career structure and mapped routes for progression will be helpful with retention. A sense of job satisfaction was another important factor in retention. A pay structure linked to a career pathway framework, such as in human-centred nursing, is an area for further work.

Factors influencing the transition and retention of mental health nurses during the initial years of practice: Scoping review

AIM

This review aims to identify the factors influencing the transition and retention of mental health nurses during the initial years of practice, recognize gaps in the literature and propose evidence-based strategies.

BACKGROUND

Mental health is a challenging specialty; recruitment, transition and retention of mental health nurses are known issues of concern.

EVALUATION

The present study undertakes a scoping review to identify factors influencing the transition and retention of mental health nurses during the initial years of practice and the gaps in that research domain. A literature search was conducted using electronic databases. To gain an understanding of the topic of interest, the review of the literature extended from 2000 to 2022.

KEY ISSUES

Existing evidence focuses on specific perspectives of transition. There is limited literature on factors influencing transition and retention among mental health nurses. Findings suggested that personal and professional factors could influence the transition and retention of mental health nurses during the initial years of practice. The main themes identified were personal attributes and professional factors with a number of subthemes.

CONCLUSION

The scoping review identified only a few studies, which showed personal and professional factors related to the transition and retention of mental health nurses at the early stages of their career.

IMPLICATIONS FOR NURSING MANAGEMENT

Potential benefits of effective transition and support with the understanding of factors influencing transition and retention of early career mental health nurses will enhance staff morale, sustainability of the workforce and better patient outcomes. Additionally, a few recommendations for nurse managers and leaders to improve transitional experiences and retention of early career nurses are highlighted.

Transition to Practice Programs in Nursing: A Rapid Review

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

New graduate registered nurses: Risk mitigation strategies to ensure safety and successful transition to practice

The COVID-19 pandemic has impacted traditional pathways for new graduate registered nurses (NGRN's) transition to practice. In response to stay at home emergency orders in 2020, NGRN's experienced changes in pre-licensure curriculum, clinical practicums, NCLEX testing, and licensure, all which influence preparedness for professional practice. The adverse impact on education and clinical training extends to all nursing students who attended higher education institutions of learning during 2020 to present and is a significant consideration with new graduates over the long-term, whom will be caring for patients in healthcare settings. Well before this pandemic, literature identified that NGRN's were predisposed to knowledge-practice gaps and lacked situational awareness. Recent nursing research emerging from the pandemic reveals a potentiating negative impact of the abbreviated pre-licensure experiences on patient safety in the clinical setting. In the current healthcare environment, it is preemptive for healthcare institutions and schools of nursing to work cohesively to ensure patient safety through an increased emphasis on evidence-based approaches to reduce patient harm and mitigate harm when it does occur. Further, in response to the increased demand for nurses by healthcare organizations, considerations for safety, risk management, and ethical care must be considered during the transition to practice for NGRN's.

İşe Yeni Başlayan Genç Hemşirelerin Kıdemli Meslektaşları ile İlişkileri: Fenomenolojik Bir Çalışma

Giriş: İşe yeni başlayan genç hemşirelerin uyum süreçleri, arkadaşça olmayan davranışlara maruz aldıkları çalışma ortamlarından olumsuz etkilenmektedir. Bu nedenle, işe yeni başlayan genç hemşirelerin deneyimledikleri meslektaş ilişkilerinin bilinmesi uyum süreçlerinin iyileştirilmesi açısından önemlidir. Amaç: İşe yeni başlayan genç hemşirelerin, çalışma yaşamlarının ilk altı ayında kıdemli meslektaş ilişkileri ile ilgili deneyimlerinin, düşüncelerinin ve duygularının özünü anlamaktır. Yöntem: Araştırma, tanımlayıcı fenomenolojik nitel tasarımda, Nisan-Ağustos 2021 tarihleri arasında İzmir’deki bir üniversite hastanesinde amaçlı örneklem yöntemiyle seçilen 14 işe yeni başlayan genç hemşire ile gerçekleştirilmiştir. Derinlemesine görüşmeler video konferans yöntemi ile yapılmıştır. Görüşme dökümleri Colaizzi’nin tekniğine göre analiz edilmiş ve çalışmanın ana temalarının oluşturulması aşamasında deneyimlerin özüne ulaşmak için “Watson İnsan Bakım Kuramı” kullanılmıştır. Bulgular: İşe yeni başlayan genç hemşirelerin, kıdemli meslektaşlarıyla olan ilişkileri üç ana tema ve iki alt temadan oluşmaktadır: ana temalar; “sevecen/olumlu yaklaşımlar”, “nezaketsiz davranış”, “yetersiz destek”; alt temalar;“destekleyici ve geliştirici yaklaşım”, “kabul görme ve önemsenme” olarak belirlenmiştir. Sonuç: Çalışmanın sonuçları, işe yeni başlayan genç hemşirelerin, geçiş sürecinde özellikle rehber hemşire yaklaşımlarını sevecen ve geliştirici bulması ve olumlu deneyimler yaşamasının destekleyici ilişkinin varlığını; öte yandan yönetici ve kıdemli meslektaşlarının nezaketsiz davranışlarına maruz kalmasının ve yardım görmemesinin olumsuz ilişkilerin varlığını ortaya koymuştur. İşe yeni başlayan genç hemşirelerin, geçiş sürecinde olumsuz meslektaş ilişkilerine maruz kalmasının önlenmesi için kurumsal ve ulusal düzeyde Watson’ın İnsan Bakım Kuramı’na temelli stratejiler geliştirilebilir.

A Longitudinal View of Perceptions of Entering Nursing Practice During the COVID-19 Pandemic

Background The COVID-19 pandemic significantly changed the landscape of health care and transition to practice for new graduates. The purpose of this pilot study was to explore the effects of the pandemic on the first-year experience of new nurses. Method A longitudinal, observational, descriptive study design was used. One hundred eighteen survey links were sent to new bachelor of science in nursing graduates from June 2020 to May 2021, with 56 responses to the first survey. Results Participants indicated the COVID-19 pandemic negatively affected the new graduate experience, resulted in concern for personal health and safety, and negatively altered preparation for the first year in practice. However, desire to be a nurse and view of nursing remained positive. Conclusion The first year in practice is stressful and challenging. The pandemic posed additional challenges to employers and new graduates. Future research should explore the long-term impact of the pandemic on an already strained nursing workforce. [J Contin Educ Nurs. 2022;53(6):256-263.].

Newly-graduated nurses' work-integrated learning: A qualitative study from an educational and occupational perspective

AIM

The aim of this study was to describe newly graduated nurses' (NGNs') experience of work-integrated learning (WIL), from an educational and occupational perspective.

BACKGROUND

NGNs often find themselves unprepared to meet occupational demands on their competence on entering working life, and express difficulties integrating educational theory into a practical context. Qualitative and effective WIL becomes particularly important for NGNs to develop the competence required to handle the transition from education to working life.

DESIGN

This is a qualitative, descriptive study with an inductive approach.

METHODS

Seven focus-group discussions were performed and subjected to qualitative content analysis.

RESULTS

The results revealed that WIL for NGNs includes personal mastering of several professional roles: a self-directed and collaborative learning role, a relational nursing role, and a transition from a student role to a collegial role. Furthermore, WIL entails adapting to organisational requirements, including development of contextual workplace knowledge and understanding; striving for confidence in medical-technical performance; and developing an experience-based understanding of clinical situations.

CONCLUSION

The results reveal that WIL is complex, encompassing adaptation to roles and personal capabilities that increase new graduates' competence and preparation for work. In addition, WIL requires personal commitment to one's own learning as well as organisational and social support.

Nursing students' competence profiles in gerontological nursing-A cross-sectional study

AIM

The study aimed to describe and explain the self-assessed gerontological nursing competence levels of Finnish nursing students and factors relating to it.

DESIGN

A cross-sectional study design, reported by The Strengthening the Reporting of Observational studies in Epidemiology guidelines.

METHODS

Data were collected with the GeroNursingCom instrument, which features 53 items relating to 11 competence factors. The K-clustering technique and the Chi-squared, Kruskal-Wallis and Mann Whitney tests were used to analyse the data.

RESULTS

Seven hundred and ninety-nine nursing students from nine randomly selected higher education institutions were invited to participate in 2019. Three distinct student profiles were identified according to the data (N = 274): Profile A-lower intermediate competence (23.1% of students), Profile B-intermediate competence (45.8%) and Profile C-high competence (31.1%). The strongest competence area for all students was appreciative encounter and interaction, and the weakest was supporting the older person's sexuality. Nursing students have diverse backgrounds and their overall competence in gerontological nursing is shaped in part by their previous education, motivations and work experience.

RELEVANCE TO CLINICAL PRACTICE

Recognizing students' different gerontological nursing competence profiles enables the implementation of targeted education to improve competence in clinical practice.

The best of both worlds - entering the nursing profession with support of a transition programme

BACKGROUND

Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition.

AIM

The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers.

METHOD

The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology.

FINDINGS

"Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge.

CONCLUSION

Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

Resilience among nurses working in paediatric wards in Brunei Darussalam: A qualitative study

Background

Resilience has become highly relevant for nurses working to avoid the negative impact of stress and maximise the positive benefits.

Objective

This study aimed to explore and describe experiences of resilience among nurses when they first started working in paediatric wards.

Methods

A qualitative, interpretive descriptive approach was used to guide the study. Purposive sampling was employed to recruit 8 participants, which proved sufficient to achieve theoretical saturation. Semi-structured individual interviews were conducted in 2020 and audio recorded. An inductive analytic approach was utilised.

Results

Three overarching themes arose from the analysis: (1) The transition period (2) Gaining the trust of others (3) Having a positive mindset.

Conclusion

This study found that nurses used multiple strategies of resilience in order to cope with workplace stress when they first began the transition period. However, as they become familiar with the workplace and gain the trust of others, this factor enables nurses to have a positive outlook toward job setbacks.

Professional nurses' perceptions regarding clinical competence of community service nurses in North West province, South Africa

Background

South African Nursing Council requires nurses who successfully complete their training to perform a year of community service before obtaining registration as professional nurses (Regulation 425). Community service for health professionals was introduced as a strategy to retain newly qualified professionals within the country. The premise is that community service for newly graduated nurses gives them the opportunity to develop skills and acquire knowledge critical in their professional development.

Aim

To explore and describe the perceptions of professional nurses as the supervisors of community service nurses (CSNs) during their 12 months of community service.

Setting

Selected hospitals of the North West province, South Africa.

Methods

A qualitative, exploratory and descriptive design was used. The study was conducted between September and November 2018 at three public hospitals in the North West province. Through purposive sampling, 15 professional nurses who supervise CSNs participated in the study. Data were collected in three focus group discussions using semi-structured questions. All focus group discussions were recorded and transcribed for analysis. Data were analysed using Pienaar’s four steps of thematic analysis.

Results

Three themes emerged: perceptions of clinical competence, challenges impacting clinical competence and suggestions to improve clinical competence.

Conclusion

It is suggested that even though the majority of CSNs were perceived to be competent and capable of working independently, they still required supervision and mentorship to refine their competency. Furthermore, the study reported similar challenges noted from previous studies that were perceived to be affecting CSNs’ ability to deliver quality health care, and therefore recommendations for improvement were made.

Contribution

The study contributed to the developed the clinical competence evaluation tool which will be of benefit to the future community service nurses in the province.

Start Healthy and Stay Healthy: A workplace health promotion intervention for new graduate nurses: A mixed-methods study

AIMS

This study explored the acceptability of a workplace health promotion intervention embedded into a transition to practice (TTP) programme to assist new graduate nurses in establishing healthy dietary and physical activity (PA) behaviours from career commencement.

DESIGN

A sequential mixed methods design.

METHODS

The Start Healthy and Stay Healthy (SH&SH) intervention, informed by the Behaviour Change Wheel, was conducted in an Australian Local Health District. It included face-to-face education sessions, the use of a fitness tracker and twice-weekly short answer messages. Participants completed three online surveys: at orientation, 6 weeks and 6 months. A sub-sample participated in semi-structured interviews to explore their experience of the intervention. Interview data were analysed thematically.

RESULTS

The intervention was delivered from February to December 2019. A total of 99 nurses completed the baseline survey, 62 at 6 weeks and 69 at 6 months. After 6 months, health knowledge increased as participants correctly identified recommended amounts of fruits, vegetables and PA. Fruit consumption increased at 6 months with little change to vegetable intake. Takeaway consumption decreased, but consumption of some discretionary foods increased. Across the three time points, there was a low engagement in PA during leisure time. The interviews identified three themes: (1) Support of Colleagues and Peers, (2) The Work Environment and (3) Engagement with SH&SH.

CONCLUSION

Providing a targeted intervention for new graduate nurses embedded into a TTP programme improved their health knowledge, some dietary behaviours, and participation in PA by some participants.

IMPACT

Ensuring a healthy nursing workforce is critical to retaining staff. Implementing a workplace health promotion intervention that targets new graduate nurses can help them adopt and maintain healthy lifestyle behaviours to support them in their future careers.

Development and psychometric testing of the Reality Shock Scale for newly graduated nurses

AIM

This study aimed to develop and psychometrically test a Reality Shock Scale for newly graduated nurses.

DESIGN

An instrument development and validation study.

METHOD

A four-phase structure was used: (1) determining the conceptual foundation (2) creating the items, (3) preliminary evaluation of items and (4) refining the scale and evaluating psychometric properties. The scale was evaluated in terms of content and construct validity. To assess its reliability, the scale was tested for internal consistency and a test-retest approach was applied. The psychometric characteristics of the scale were tested with 1310 newly graduated nurses working in different positions at 19 hospitals. Data were collected over the period January 2018-July 2019.

RESULTS

Prior to the creation of the scale items, a scan of the literature was carried out, after which individual face-to-face, semi-structured in-depth interviews were held with the newly graduated nurses. The scale's Content Validity Index was 0.97. A 47-item scale containing four subdomains (Relations and Cooperation, Professional Knowledge, Responsibilities, Performance) was developed as a result of the analyses; the scale explained 48.4% of total variance. The confirmatory factor analysis confirmed the scale's four-factor construct. Cronbach's α was calculated as .95 for the overall scale.

CONCLUSION

The Reality Shock Scale that was developed is a valid and reliable measure that can be used to determine the extent to which newly graduated nurses experience reality shock.

IMPACT

The developed tool makes it possible to determine the reality shock experienced by newly graduated nurses and influencing factors. Thus, educational institutions as well as health institutions have the means to develop policies to prevent reality shock experienced among newly graduated nurses.

Use of Simulation in Teaching Nursing Leadership and Management Course: An integrative review

Nursing education is strategically positioned to prepare nursing students for management and leadership skills necessary for future professional nursing roles. This review appraised and synthesised the outcomes of using simulation in pre-licensure nursing management and leadership courses. This is an integrative review of original articles published between 2008 and 2018. In January 2019, PsychINFO, CINAHL, PubMed and SCOPUS were searched to identify relevant articles using the following terms: ‘management’, ‘leadership’, ‘simulation’, ‘nursing’, ‘education’ and ‘student’. A total of 10 articles were included in the review. Four essential themes were identified from the content analysis: acquisition of skills or understanding of delegation, enhanced teamwork or collaboration capacities, improved decision-making and problem-solving skills and increased communication skills. Incorporation of simulation in the nursing management and leadership courses has the potential to enhance nursing students’ skills regarding delegation, problem-solving capacities, decision-making and communication and teamwork.

COVID-19 pandemic impact on experiences and perceptions of nurse graduates

BACKGROUND

Transitioning from education to practice is stressful for new nurses and those entering new roles and can lead to workforce attrition and burnout. This dynamic is likely complicated when graduates are transitioning to practice during a pandemic.

PURPOSE

The purpose of this study was to describe recent nurse graduates' perceptions of the impact of the COVID-19 pandemic on their transition from education to practice.

METHODS

We conducted an online survey of BSN, RN-BSN, and DNP students who graduated between December 2019 and April 2020 (n = 82), including demographics, employment information, and free-response questions about the impact of the pandemic on their transition experiences, post-graduation plans, and perceptions of nursing. We used a qualitative descriptive approach to content analysis to synthesize and summarize the data.

RESULTS

Participants expressed three overarching concerns: 1) altered plans such as difficulty finding employment; 2) logistical, system-related stressors including licensing delays and chaotic onboarding; and 3) feeling pride in profession despite perceiving ambivalence in public discourse.

CONCLUSION

COVID-19 exacerbated challenges often experienced by new graduates. Common stressors, intensified during the pandemic, could exert long-term effects on the workforce. Educators and healthcare organizations must work to ensure nursing graduates receive the necessary support for a successful transition.

The Effect of Simulation-Enhanced Orientation on Graduate Nurses: An Integrative Review

The purpose of this review is to examine the state of science of simulation-enhanced orientation and its effect on graduate nurses (GNs).

BACKGROUND

GNs are essential to the alleviation of staffing deficits, mitigation of patient safety events, and provision of clinically adept care. Successful transition from academia to clinical practice is often influenced by factors that compromise retention, increase attrition, and impair professional development.

METHOD

The method used was an integrative literature review.

RESULTS

There is a paucity of research in the literature regarding the effect of simulation-enhanced orientation on clinical competency, confidence outcomes, and other benchmarks of professional development that may influence retention or attrition.

CONCLUSION

This integrative review confirmed the paucity of research of qualitative and quantitative outcomes of simulation-enhanced orientation on GNs. Stakeholders of organizational and educational institutions may find this review valuable, as it highlights the necessity for additional research. [J Contin Educ Nurs. 2021;52(3):150-156.].

Clinical sympathy - A mixed method study of the relationship between the clinical nurse educator and the graduate nurse

AIM/OBJECTIVE

This paper sought to investigate the influence of the supernumerary clinical nurse educator role on the newly qualified graduate nurses' professional development and successful transition to competent and confident practitioners in the acute care hospital environment.

BACKGROUND

The novice nurses learning in the inpatient clinical environment is affected by increasing patient acuity, complex conditions and organisational expectations. The supernumerary clinical nurse educator is uniquely positioned to prioritise these nurses' education through protected and available time to support adaption in the workplace culture and retention in the organisation.

DESIGN

A convergent mixed methods design was used to investigate the relationship between the supernumerary clinical nurse educator role through the opinions and experiences of the graduate nurse.

METHODS

Data were collected in February - July 2015 from graduate nurses from three hospital sites in a healthcare organisation in Western Australia. The research used online questionnaires (n = 39) and face to face interviews (n = 10). Analysis of quantitative data used descriptive statistics and qualitative data used thematic analysis.

RESULTS

Four main themes were identified. These were: acknowledges new and challenging experiences, available to provide constructive responses, sympathises with anxiety and missing in action.

CONCLUSION

The graduate registered nurses perceived that clinical sympathy provided by the clinical nurse educator was essential to their new role of frontline nurses influencing their delivery of quality patient care and as a practical solution to champion the graduate nurses' longevity in the future nursing workforce.

International nursing students' and international nursing graduates' experiences of transition to the nursing workforce: A systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to identify and synthesise existing evidence on the experiences of international nursing students' and international nursing graduates' transition to the host country's nursing workforce.

BACKGROUND

International students' experiences of transition to the host country has been extensively explored by researchers. International students experience unique challenges related to communication and language, socialisation, finance, and temporary student visa. One under-researched area is the experiences of transition for international nursing students and international nursing graduates. This systematic review examined the existing evidence on international nursing students' and international nursing graduates' experiences of transition to the host country's nursing workforce.

INCLUSION CRITERIA

This review considered published and unpublished studies-qualitative, quantitative, mixed methods, evidence syntheses, and grey literature-that included international nursing students enrolled in an undergraduate nursing programme outside their home country and international nursing graduates, either employed or not yet employed in nursing and within their first year of completing an undergraduate nursing programme outside their home country.

METHODS

A three-step search strategy was utilised in this review. The search strategy aimed to find published and unpublished literature in English from January 2000 to April 2020. The databases searched were Ovid Medline, Scopus, Emcare, ERIC, PsycINFO, ProQuest Central, ProQuest Dissertations and Theses Global, JBI Evidence-based Practice Database, and ScienceDirect. Two reviewers independently screened the titles/abstracts and full texts of studies for inclusion and appraised the methodological quality of the included studies. Findings and accompanying illustrations were extracted by one reviewer, assigned a level of credibility, and checked by the others. Results were analysed using JBI's approach to qualitative meta-aggregation.

RESULTS

This review included three qualitative papers published between 2011 and 2018. All included studies were appraised as of moderate quality. Sixty-five study findings and nineteen categories were aggregated into the following six synthesised findings: international nursing graduates developed confidence and satisfaction through challenges; personal challenges; clinical challenges; discrimination and justice; academic barriers to success; and what international nursing students liked and wanted.

CONCLUSION

The synthesised findings revealed ongoing anxiety, lack of preparedness and role uncertainty that was experienced by international nursing students and international nursing graduates as they transition to the host country's nursing workforce. They expressed the need for information about professional role expectations, guidance, and support to transition. University transition programmes and services could provide support to address the workforce transition challenges faced by international nursing students and international nursing graduates.

TWEETABLE ABSTRACT

Systematic review shows international nursing students and international nursing graduates experience anxiety, limited preparedness and role uncertainty when transitioning to the host country's nursing workforce.

Clinical coaches and patient safety - Just in time: A descriptive exploratory study

Patient safety in hospitals is a key priority. Clinical coaches who educate, support and coach staff to deliver safe, high quality care, are ideally placed to positively influence patient safety.

AIM

This study aimed to understand how clinical coaches in an education role, manage risk and support patient safety at the point of care.

BACKGROUND

Patient safety has developed from a find and fix reactive model towards an approach which focuses on human performance, aiming to understand how individuals adapt and respond in complex systems to ensure 'things go right'. Clinical coaches working as educators at the point of care, are uniquely placed to ensure 'things go right', supporting staff to anticipate and proactively respond to emerging issues, particularly when complex practice situations change unexpectedly. Clinical coach experiences of intervening 'just in time' to prevent errors incidents or omissions occurring at the point of care is unknown.

DESIGN

This was a descriptive exploratory study conducted with registered nurses working in the role of clinical coach (n = 29).

METHODS

Study data were collected through a purposefully designed survey.

RESULTS

Clinical coaches intervened 'just in time' across a variety of clinical situations including medication errors, clinical procedures, documentation, assessment skills and clinical handover. Lower skill mix, higher patient acuity and the commencement of new staff influenced clinical coach 'just in time' interventions. Most of the clinical coaches had intervened with both junior and senior members of staff. Overall, clinical coaches spent up to 3-4 h every day proactively managing risk across a variety of clinical situations and staff.

CONCLUSIONS

Clinical coaches play an important role in ensuring patient safety by regularly intervening 'just in time' to prevent errors, omissions, or incidents from occurring at the point of care. The clinical coach role, which educates and supports staff to deliver safe, high quality care, makes a valuable contribution towards patient safety.

Facing COVID-19 Pandemic in a Tertiary Hospital in Milan: Prevalence of Burnout in Nursing Staff Working in Sub-Intensive Care Units

In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.

"Hoping to be recognized, appreciated, and given clinical privilege": A phenomenology study of new nurses' experiences during orientation

New nurses who have just worked have not been given clinical privilege during their orientation. Feelings, experiences, and expectations can influence the quality of nursing services. This study aimed to explore the experiences of new nurses, especially in the orientation period, before they are given the clinical privilege. This research applied a descriptive qualitative phenomenology design-semi-structured, in-depth interviews. Data were analyzed by the Colaizzi method using thematic analysis. Four themes: new nurses lack understanding of clinical privilege; new nurses provide nursing care based on senior orders; new nurses want to be recognized, appreciated, and given clinical privilege; and hospitals need to facilitate the process of adaptation of new nurses. This study shows that the new nurse carries out nursing care in the hope of being recognized and developing skills. Nurse managers are expected to provide appropriate orientation programs.

A narrative inquiry approach to understanding senior intensive care nurses' experiences of working with new graduate nurses

AIMS AND OBJECTIVES

To report a qualitative inquiry exploring senior registered nurses' stories of experience working with new graduate nurses in the intensive care unit.

BACKGROUND

While new graduate nurses' perceptions of transitioning into professional practice in the intensive care unit have been examined, few studies have explored the experiences of the senior registered nurses working alongside them.

DESIGN

A narrative inquiry methodology informed by Dewey's (1938) theory of experience.

METHODS

Individual in-depth, unstructured, interactive interviews were conducted with five senior registered nurses. The inquirer co-composed individual narrative accounts with each participant. Narrative inquiry's three commonplaces of temporality, sociality and place formed the lens of analysis. Thematic analysis identified two overarching threads that resonated across the narrative accounts. This inquiry adheres to COREQ checklist reporting.

RESULTS

The overarching threads 'Reverberations' and 'Caring' depict the experiences of senior registered nurses. 'It's Dangerous', 'Patrolling Like Surf Lifesavers', 'We Carry Them', 'Survival Mode' and 'Enjoyable Moments' are minor threads describing the challenges, while 'I've Been There', 'They Must Ask Questions' and 'Not In My Backyard' reveal their insights.

CONCLUSIONS

Working with new graduate nurses increased senior registered nurses' patient surveillance and workload, contributing to stress, pressure and feeling overwhelmed. However, senior registered nurses felt an obligation to care for new graduate nurses, who they perceived as still acquiring the skills to autonomously care for critically ill patients. Therefore, senior registered nurses require support themselves.

RELEVANCE TO CLINICAL PRACTICE

Senior registered nurses perceive workplace constraints as impeding their capacity to provide sufficient support and surveillance to new graduate nurses. The gap between new graduate nurses' clinical capacity and patients' needs underpins senior registered nurses' recommendation that new graduate nurses should not be placed in intensive care units unless additional workforce support is provided, safeguarding their development as well as patient safety.

Nursing students' experiences with clinical placement in residential aged care facilities: a systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on nursing students' experiences with clinical placement in residential aged care facilities.

INTRODUCTION

Nursing education programs play a key role in preparing future nurses to care for the growing number of older adults who will require health care. A key component of this preparation involves ensuring that curricula optimize student learning through carefully designed clinical learning practice experiences. Residential aged care facilities provide students with opportunities to work exclusively with older adults. Studies that address clinical placements in residential aged care facilities highlight both the benefits and concerns of student learning and professional development. Insight into student experiences of clinical placements in residential aged care facilities can help inform nursing curricula and contribute to a better understanding of how best to prepare students to care for an aging population.

INCLUSION CRITERIA

This review considered all qualitative studies that included undergraduate and diploma nursing students. Nursing students included individuals or groups identified as nursing students independent of the type of program, level of learning, or time spent in the setting.

METHODS

A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the JBI Critical Appraisal Checklist for Qualitative Research. Key findings were extracted and classified as unequivocal or credible.

RESULTS

Fourteen qualitative studies were included, published between 2003 and 2018. A total of 53 findings were extracted and aggregated into seven categories. From the seven categories, two synthesized findings were developed: the evolution of learning and embracing opportunity.

CONCLUSION

This review captured student experiences of clinical placement in residential aged care facilities. The findings highlight the importance of students entering the setting with knowledge of how to care for older adults and being able to respond to challenging resident behavior. Equally important is the need for students to understand the roles and contributions of all care staff in the setting, including nurses and unregulated care providers. Although the residential aged care setting can be a challenging learning environment for students, it also offers opportunities for student growth and professional development, especially when there are clearly articulated learning outcomes and appropriate role models available.