Glimpses into the transition world: New graduate nurses' written reflections

Critical soft skill competencies that clinical nurse educators consider important to evaluate in nurses

AIM

Guided by Benner's framework, From Novice to Expert, this study aimed to identify (1) critical soft skills to be evaluated in nurses and (2) levels of nursing behaviour indicating achievement of soft skills to provide a framework for developing a soft skills rubric.

BACKGROUND/INTRODUCTION

Nurse shortages are often attributable to high turnover rates among nurses. To improve this situation, healthcare facilities implement transition programmes and continuing education with a primary focus on developing and maintaining nurses' knowledge and performance (hard skills). However, balancing hard and soft skills (beliefs, values and attitudes) is key to nurses' quality of care and ultimately to their retention. Despite the importance of soft skills, their intangible nature creates problems in evaluating nurses' attainment of these skills and in providing constructive feedback to help them set concrete goals for improving their practice.

METHODS

This qualitative descriptive study described critical soft skills in the nursing context. A purposeful sampling strategy was used to enrol 13 clinical nurse educators from multiple hospital units; each had more than 2 years of clinical nurse educator experience and had completed preceptor training. One-to-one interviews with these individuals were audio recorded, transcribed and subjected to direct content analysis using NVivo 12. The study follows the Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative studies.

FINDINGS

Five main competencies, comprising 20 subcompetencies, were identified: personal growth, effective interactions, professionalism, teamwork and the caring role. For each subcompetency, four skill levels were delineated using clinical indicators.

CONCLUSION

This study's findings can enhance understanding of clinical nurse educators' perceptions regarding soft skills required of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The soft skills identified can be incorporated into a rubric to be used by clinical nurse educators to evaluate and guide nurses' professional development and contribute to improving quality of care. No patient or public contribution is required for this study.

Readiness levels of intern nursing students during the transition to professional practice within the Al Jouf Region in Saudi Arabia

BACKGROUND

The transition of newly graduated nurses into the workforce is recognized as a complex undertaking and has been examined extensively in the literature.

OBJECTIVE

This study aimed to assess the readiness levels of intern nursing students and investigate the factors affecting their transition to professional practice within the Al Jouf region in Saudi Arabia.

METHODS

The study employed a combination of descriptive, correlational, and qualitative methodologies to conduct its investigation. Data were acquired via an online questionnaire that included demographic information, the Nursing Practice Readiness Scale (NPRS), and two open-ended questions. A total of 135 nursing intern students were recruited to participate in the study. Benner's "novice-to-expert" theory of clinical competence was utilized to guide the theoretical underpinning of the study.

RESULTS

Findings revealed that most intern nursing students (63.7%) exhibited a moderate level of readiness. Furthermore, 70.4% and 55.6% of the students showed moderate readiness in terms of their professional attitudes and patient-centeredness, respectively. More than one-third of the students demonstrated a high level of readiness in the self-regulation domain (36.3%), while a similar proportion indicated a high level of readiness in the domain of collaborative interpersonal relationships (33.3%). The students underscored their reliance on the education system as pivotal in enhancing their preparedness for clinical practice.

CONCLUSION

Nursing internship programs contribute to a more comprehensive readiness of nurses for active participation in clinical practice as compared to traditional educational programs.

Exploring work readiness: A qualitative descriptive study of self-perceptions among new graduate nurses

Background

Reduced work readiness is associated with elevated turnover rates, necessitating efforts to enhance the positive work readiness of newly graduated nurses to alleviate the shortage in the nursing workforce. Research into the work readiness of recent nursing graduates in China is still in its infancy. Most studies employ quantitative research methods, and further exploration of the self-perception of work readiness among new nurses in China is required.

Objectives

This study aimed to investigate genuine experiences and self-perceptions of work readiness among new graduate nurses.

Design

A qualitative descriptive study.

Methods

Sixteen new nurses from a provincial tertiary hospital in China were included in this study, which adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist for reporting. The data collection process involved conducting semi-structured interviews from September to October 2021. Inductive content analysis was employed to analyze the interview data.

Results

The study identified four themes encompassing new nurses' real-life experiences and self-perceptions of work readiness: psychological stress, emotional conflict, empathy fatigue, and ethical dilemmas. Psychological stress comprised three subthemes: knowledge and skill deficits, communication barriers, and fear. Empathy fatigue was primarily characterized by psychological and physical symptoms. Ethical dilemmas involved conflicts over differences in values and between clinical reality and standardized nursing practice.

Conclusion

Drawing from the self-perceptions of work readiness among new nurses found in this study, nursing administrators and educators must enhance the existing transition support program for new nurses. Additionally, the establishment of individualized training programs is recommended to further improve the work readiness of new nurses.

Appraising differential capabilities of new graduate nurses: Development across the first nine months of employment

BACKGROUND

Effective transition to practice for new graduate nurses (NGNs) is of national and international concern. Development of NGNs expands well beyond higher education studies and relies heavily on support during their first year of employment. Little is known of the differential development of NGNs, namely the trajectory of developing capability.

AIM

This study differentiates NGN development during their first year of employment through appraisal of universal domains of nursing practice relevant to the international community.

METHODS

Using a quantitative evaluation design NGN performance was appraised at 1-, 3-, and 9-months from February 2020 to November 2021, using a 23-item appraisal tool and accompanying behavioural cues organised around four universal domains of practice: professional values and behaviours; comprehensive nursing practice; organisational capabilities; personal growth and development; and a fifth domain specific to Australia, that is, legislative requirements. Workplace performance was appraised by clinical supervisors and numerically rated according to intensity of coaching required to meet requisite standards of practice.

RESULTS

The shift in rating scores of intensity of coaching required, over three time periods across four key universal domains, were statistically significant (p < .001). These findings which indicate the intensity of required coaching for maintenance of standards reduced over the time period suggest advancing NGN capability. The domain representing professional values consistently rated the highest. The domain denoting legislative requirements largely flattened after three months.

CONCLUSION

These findings corroborate the significant development of NGN capability during the first nine months of employment, especially during the initial three months. Furthermore, they provide empirical evidence that NGNs are most adept at demonstrating professional values; a recognised capability developed through employment during pre-registration studies. Discriminant data is of value to inform both targeted development of individual NGNs and when collated, the education needs of cohorts.

A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study

BACKGROUND

Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction.

METHODS

A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression.

RESULTS

Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation.

CONCLUSIONS

Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

Medical students' reflective capacity and its role in their critical thinking disposition

BACKGROUND

Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition.

METHODS

In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20.

RESULTS

The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, "active self-appraisal (SA)" and "reflective with others (RO)" had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students' critical thinking disposition.

CONCLUSION

The relationship between students' reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Belonging in high acuity settings: What is needed for newly graduated registered nurses to successfully transition? A qualitative systematic review

BACKGROUND

A worldwide shortage of nurses providing clinical care, coupled with an increase in severity of illness of hospitalised patients has led to newly graduated Registered Nurses being placed into high acuity settings, such as the emergency department, intensive care unit and operating theatre. The feeling of belonging in these settings impacts on successful transition of newly graduated Registered Nurses, their learning, and may lead to high attrition rates.

OBJECTIVE

To comprehensively synthesise qualitative research on newly graduated Registered Nurses' experiences of belonging, while working in high acuity clinical settings.

DESIGN

Elements of the Joanna Briggs Institute (JBI) systematic review protocol were utilised. The Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to conduct the review. Data were analysed using thematic analysis.

DATA SOURCES

Ovid Emcare, PsychInfo, CINHAL, Proquest and Scopus.

METHODS

The PICo (population, interest and context) strategy was used as a guide to develop search terms. Published literature from January 2007 to April 2021 was searched. Screening, selection and data extraction were performed by two authors independently. All discrepancies were resolved through discussion with a third reviewer.

RESULTS

A total of 506 studies were identified following the systematic search; after duplicates were removed, 440 were screened by title and abstract and 29 by full text. Six articles were included in this systematic review. Methodological quality was assessed utilising the JBI critical appraisal checklist, and discrepancies ratified through team consensus. The themes; emotional lability, structured program design, preceptors' influence and acceptance were identified.

CONCLUSIONS

Newly graduated Registered Nurses in the high acuity setting feel emotionally insecure related mainly to their educational unpreparedness. They have need for a structured program, inclusive of both theory and supported practice. The role of the preceptorship team is vital in enabling a feeling of belonging, as is acceptance by nursing staff of the learning journey.

Exploring how reflective practice training affects nurse interns' critical thinking disposition and communication skills

BACKGROUND

It is useful for nurses to be able to engage in reflective practice. Reflective practice is an essential aspect of experiential learning.

AIM

To explore how reflective practice training during an internship programme in Saudi Arabia affected nurse interns' critical thinking disposition and interpersonal communication competency.

METHOD

A convenience sample of 93 senior nursing students undertaking the internship programme at a nursing college in a university in Saudi Arabia answered a questionnaire before and after taking part in reflective practice training sessions. The questionnaire used three tools: the Reflective Practice Questionnaire; the Critical Thinking Disposition Scale; and the Interpersonal Communication Competency Scale.

RESULTS

After the training, the overall mean scores for reflective practice, critical thinking disposition and interpersonal communication competency were significantly higher than before the training. Reflective practice had a positive correlation with critical thinking disposition and interpersonal communication competency. It also had predictive capability for the variance in critical thinking disposition and interpersonal communication competency (R 2 =0.798 and R 2 =0.553, respectively, P <0.001).

CONCLUSION

Reflective practice training provided to nurse interns in Saudi Arabia improved their reflective practice, critical thinking and interpersonal communication. Reflective practice training would be a useful addition to pre-graduate nurse education and to preceptorship or orientation programmes for newly recruited nurses.

Transition to Practice: The Use of Virtual Clinical Replacement During the COVID-19 Pandemic and Its Impact on New Graduate Nurse Readiness

AIM

This study investigated graduate nurse readiness for practice after receiving virtual clinical replacement experiences during the COVID-19 pandemic.

BACKGROUND

The pandemic led to the closure of clinical sites for many undergraduate nursing students. Nurse educators replaced the hospital setting with virtual clinical replacement experiences, potentially affecting readiness for practice in graduate nurses.

METHOD

The Casey-Fink Graduate Nurse Experience Survey was used to collect data in the areas of demographics, comfort level with skills, work environment stress, job satisfaction, role transition, and the impact of the virtual clinical experience on transition to practice. Descriptive statistics and independent t -tests were used for analysis.

RESULTS

The virtual clinical replacement experience was statistically significant with greater confidence in providing for patient safety, stronger professional communication/leadership skills, and recognized support in the workplace.

CONCLUSION

The use of virtual clinical replacement experiences had a positive impact on new graduate nurses' transition to practice.

PROFESSIONAL DEVELOPMENT AMONG NEWLY GRADUATED REGISTERED NURSES WORKING IN ACUTE CARE HOSPITAL SETTINGS ‐ A QUALITATIVE EXPLORATIVE STUDY

AIM

To explore newly graduated registered nurses' perceptions of their work situation and management of nursing care in complex patient situations after 18 months of work experience.

BACKGROUND

Newly graduated registered nurses working in acute care hospital settings play a critical role in providing safe nursing care.

METHODS

An explorative qualitative design, with four focus group interviews with 14 newly graduated registered nurses working in acute care hospital settings.

RESULTS

One theme emerged: 'Clarity and security in one's own nursing role despite facing challenges that hinder professional development' and three categories: 'Independency due to one's own efforts and experience', 'Well-functioning teamwork' and 'Challenges in the work situation'.

CONCLUSION

After 18 months in the profession, the nurses were considered to be advanced beginners; at the same time, the most experienced nurses on their respective wards. They found it challenging and need to further develop competences concerning managing and organizing the nursing care of several complex patient situations or new patient groups, as well as supervising novice registered nurses and nursing students.

IMPLICATION FOR NURSING MANAGEMENT

Powerful and urgent action is needed to be taken by national healthcare policymakers as well a hospital and nurse managers to develop long-term strategies to improve working conditions for newly registered graduated nurses.

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.

Role Transition of Newly Graduated Nurses: A qualitative study

BACKGROUND

Newly Graduated Nurses in different socio-cultural contexts confront dissimilar situations and influences on role transfer. It is important to understand how newly graduated nurses reconstruct their own professional concept of clinical nurses.

OBJECTIVES

This study aimed to explore how Taiwanese newly graduated nurses perceived their new role and the process through which they transition into the professional role.

METHODS

Charmaz's constructivist grounded theory guided the study's design and implementation. Purposive and theoretical sampling and the snowball technique were used to recruit 30 participants from 3 tertiary and 2 community hospitals in Taiwan. Interviews were audio-recorded and transcribed verbatim into a readable format. Initial, focused and theoretical coding was utilized for data analysis. The criteria of credibility, originality, resonance and usefulness guided assessment of the study's quality and ensured the trustworthiness of the study process.

RESULTS

The process of role transition to become a nurse comprised four stages: hesitation, psychological preparation, development and appreciation. The hesitation stage was interpreted as a phase of passive learning. In the psychological preparation, newly graduate nurses began to take full work responsibility. The development stage saw them gain work confidence and, in the appreciation stage, they acquired a full picture of their roles.

CONCLUSION

To bridge the gap between theoretical learning and practice and reduce the time new graduate nurses need for role adjustment contributes to an early stage of Hesitation rather than the Appreciation stage of role transition. The findings suggest the need for further research to explore newly graduated nurses' needs during the process of role transition.

The impact of postgraduate education in transition to practice programmes on new graduate nurses' knowledge and skills: A pre- post survey design

BACKGROUND

Research indicates that nurses perceive postgraduate education to have a positive effect on their knowledge and practice. Many jurisdictions offer/require new graduate nurses to undertake postgraduate coursework however the consequences of this are not clear.

OBJECTIVES

This research aims to determine the impact of completing a postgraduate course in clinical assessment on the capabilities of new graduate nurses.

DESIGN

A two group pre/post design with a naturally occurring intervention employing an online questionnaire was used to gather data.

SETTINGS

Two metropolitan hospitals in New Zealand delivering new graduate programmes, one inclusive of a postgraduate course and the other not.

PARTICIPANTS

Eighty five nurses completed the questionnaire on commencement of the programme and fifty-two on completion of the programme.

METHODS

An online questionnaire was administered to two new graduate cohorts, on commencement and completion of their new graduate programme.

RESULTS

Results showed significant pre/post increases for four out of five factors for those who had completed a postgraduate course compared to only one significant increase for those who had not. In addition, when comparing the scores of the two groups there was no significant differences between groups on the pre-measures. However, on post measures there were significant differences with the postgraduate group scoring higher on three of the five subscales: Knowledge for Practice, Explaining Practice and Applied Diagnostic Reasoning.

CONCLUSION

It is the author's belief that this is the first study that has attempted to quantify new graduate nurses' perceptions of their educational experience in their first year of practice and suggests that the inclusion of the postgraduate course enhanced knowledge for practice and diagnostic reasoning skills.

Perceptions and experiences of nurses transitioning to primary care: A qualitative study

BACKGROUND

Transitioning to primary care is a highly stressful process for nurses due to the diverse roles and responsibilities required. Despite the global shift of health services requiring more nurses in primary care, there is a dearth of literature regarding their transition experiences.

AIM

To explore the perceptions and experiences of nurses transitioning to primary care.

METHODS

A qualitative descriptive design was used. Nineteen nurses from five primary care clinics in Singapore participated in the semi-structured interviews. These interviews gathered the experiences of nurses transitioning to primary care. Interviews were analysed using thematic analysis through an inductive and theoretical approach. Rigour was established through an audit trail, peer examination and member checking.

FINDINGS

Three themes of Idealistic assumptions, Role realignment and Seeking enlightenment emerged. These themes described the nurses' initial disorientation to the unfamiliar primary care setting; their attempts to fit in by embracing the new environment and suppressing their true emotions; and the support received coupled with their ownership to learn.

IMPLICATIONS FOR NURSING POLICY

The findings highlight the importance for nurse managers to promote positive transition experiences through the modification of existing support programmes and organizational cultures. To further enhance the nurses' retention within primary care, it is imperative for nurse educators and policy makers to revise the nursing curricula, primary care nursing career framework and recruitment campaigns at the national level. This brings clarity to the misconceptions in the roles and expectations required of nurses in primary care.

Approaches used to enhance transition and retention for newly qualified nurses (NQNS): A rapid evidence assessment

AIM

To undertake a rapid evidence assessment of approaches used to enhance nurse transition and retention for newly qualified nurses and to evaluate the strength of the evidence for specific approaches to nurse transition and retention.

DESIGN

A rapid evidence assessment was undertaken. Electronic databases were searched, and the full texts of relevant papers were retrieved. Studies were appraised using relevant Critical Appraisal Skills Programme and Mixed Methods Assessment Tools and a single descriptor of quality: high; medium; or low was assigned to each output. Given the disparity in methods, the lack of randomised trials, results could not be combined; therefore, a descriptive approach was used to synthesise and present the data.

DATA SOURCES

The search was undertaken using: specific database searching; and secondary searching of relevant websites. Electronic databases (CINAHL complete, Academic search premier, Open Grey, ERIC* (Education), Web of Science-Social Science Citation Index and PubMed) were searched during February 2018.

RESULTS

Orientation and creating supportive environments were frequently reported as being effective in enhancing transition across a range of studies. A range of methods: quasi-experimental, survey and qualitative were used. Generally, the quality of most studies was poor.

CONCLUSIONS

Despite decades of research into the experiences of newly qualified nurses and development of schemes and frameworks to support them during this period, there is little substantive or robust evidence in terms of impact on retention. Further research into the longer-term retention of newly qualified nurses is recommended. Longitudinal studies would be beneficial in assessing the efficacy of approaches to enhancing retention.

New graduate nurses' satisfaction, adaptation and intention to leave in their first year: A descriptive study

AIM

To determine the factors affecting the professional and institutional satisfaction of new graduate nurses in their first year of work, their adaptation process and their intentions of leaving the nursing profession.

BACKGROUND

The number of new graduates has been increasing in the global labour force, yet a significant proportion of them have left their profession. The first year in the nursing profession is particularly stressful and challenging for new graduate nurses.

METHODS

The study was conducted at four hospitals with 428 new graduate nurses who were in the first years of their careers.

RESULTS

The nurses' mean score, out of ten, was 5.52 points for job satisfaction and 5.16 points for satisfaction with their institution. Of them, 47.7% had difficulties adapting to nursing, and 53.5% had issues adapting to their jobs. Of them, 42.5% had considered leaving nursing, and 50.9% planned to leave their institutions.

CONCLUSIONS

New graduates that perceive high workload, poor communication with patients and families or team members or inadequate skills and knowledge are more likely to consider turnover or leaving the profession.

IMPLICATION FOR NURSING MANAGEMENT

New graduates suggested that better cooperation and teamwork, participation in decisions, consideration of requests for placement in a specific department, fair distribution of duties and shifts and in-unit professional development opportunities would all improve the work environment and decrease risk of turnover.

Undergraduate nursing student academic resilience during medical surgical clinical practicum: A constructivist analysis of Taiwanese experience

BACKGROUND

Nursing students often experience a reality shock in the course of their practicums that can significantly impact their studies.

PURPOSE

This study aimed to explore the academic resilience of undergraduate nursing students during their Adulting Nursing practicums and identify protective factors to mitigate their impact.

METHODS

The constructivist grounded theory approach enabled us to explore nursing students' academic resilience in their practicums. Purposive and theoretical sampling was used to recruit 19 participants. Individual in-depth interviews were audio-recorded and transcribed verbatim. The constant comparative method directed theoretical sampling. The criteria of credibility, originality, resonance, and usefulness were considered to ensure the quality and trustworthiness of the study.

RESULTS

The main challenges were related to facilitators, the environment, and application of techniques. Students reported feelings of 'walking on thin ice' and doubts about their decision to pursue a nursing career. Academic resilience was identified as the ability to maintain optimism while facing challenges. Participants concluded that overcoming their ignorance through practical learning was an important outcome of the process of developing academic resilience.

CONCLUSION

The findings highlight the need for facilitators to re-examine their teaching strategies and provide supplementary support to help students to improve their academic resilience.

Newly Graduated Swedish Nurses' Inadequacy in Developing Professional Competence

BACKGROUND

The learning process for student and recently graduated nurses during their transition to professional nursing is stressful and challenging. The aim of this study was to describe recent graduates' experiences of developing professional competence in their basic nursing program and during their first year.

METHOD

A qualitative descriptive design with an inductive approach based on interviews with 11 nurses, with a qualitative content analysis.

RESULTS

Recently graduated nurses experience shortages and struggle to develop their professional competence. They find that reflection is a fundamental tool in the process of professional competence development. The competence gap is not between theoretical and practical knowledge, but rather between the university and health care organizations.

CONCLUSION

Focusing on the intertwining of theoretical and practical knowledge can bridge the gap between these two organizations and create a foundation for lifelong learning of professional competence. Creating opportunities for reflection is central to the learning process. [J Contin Educ Nurs. 2020;51(2):65-74.].

First year nursing students' perceptions of learning interpersonal communication skills in their paid work: A multi-site Australasian study

Nursing students are increasingly undertaking paid work while studying and most choose paid work in health care or hospitality. This paper is drawn from a larger sequential exploratory mixed-method study which examined the relationship between students working while studying nursing and the impact on academic performance. In this paper, we explored first year nursing students' perceptions of communication skills gained through paid work. Using a qualitative exploratory design, 50 first year commencing nursing students from four nursing schools (3 Australia; 1 New Zealand) were interviewed. Inductive thematic analysis was used which identified two themes: (i) recognising the value of learning interpersonal communication skills and; (ii)opportunities to develop effective interpersonal communication skills. Paid work provides interpersonal communication skills; active listening, being present and interacting while multi-tasking and emotion management. Undergraduate education providers need to recognise the benefits of paid work for students, including enhancing interpersonal skills.

Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses

Aims and objectives

To explore newly graduated registered nurses' experiences and how they manage complex patient situations.

Background

Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.

Design

Qualitative study design.

Methods

Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.

Results

The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.”

Conclusion

The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.

Relevance to practice

Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

Determining the learning needs of new graduated nurses working in inpatient care institutions

BACKGROUND

The first year of practice impacts newly graduated nurses' adaptation to both work and profession life. During this period, new graduates most need to improve their professional knowledge and skills.

OBJECTIVES

This study determined the learning needs of newly graduated nurses working in hospitals.

DESIGN

This is a descriptive study.

SETTINGS AND PARTICIPANTS

The sample consisted of 459 newly graduated nurses at six hospitals in Istanbul in Turkey.

METHODS

The data were collected with a collection tool developed by the researchers. The data were analyzed using mean, frequency, percentage, and the chi-square test.

RESULTS

The study determined that 34.6% of the newly graduated nurses were working in the emergency room and intensive care unit and 50.5% did not choose their unit voluntarily. Although 67.8% stated that their theoretical training in school was sufficient, 53.2% found clinical and 67.3% found laboratory practices insufficient. Of them, 67.1% stated that they participated in a unit orientation program and nearly half found the program insufficient for solving clinical issues. The newly graduated nurses specified they needed to learn more about nursing interventions such as resuscitation, postmortem care, efficient crisis management and code/emergency management. Newly graduated nurses who chose their unit voluntarily, found their undergraduate education sufficient preparation for the profession, and found the orientation program effective felt more competent in nursing practices. They made several suggestions for their professional development: effective feedback, in-unit trainings, working with a mentor during the first year of practice and more clinical practice during undergraduate education.

CONCLUSIONS

This study includes data on the learning needs of newly graduated nurses and the factors that affect them. These results will be beneficial for planning studies to help newly graduated nurses to improve their skills.

Nursing Students' Experiences of Clinical Practices in Emergency and Intensive Care Units

Clinical practices are key environments for skill acquisition during the education of nursing students, where it is important to encourage reflective learning. This study sought to explore the experience of final year nursing students during their clinical placement in emergency and intensive care units and to identify whether differences exist between female and male students. Using qualitative methodology, a documentary analysis of 28 reflective learning journals was carried out at a public university in Northern Spain. Four themes were identified: "an intense emotional experience", "the importance of attitudes over and above techniques", "identifying with nurses who dominate their environment and are close to the patient in complex and dehumanized units" and "how to improve care in critically ill patients and how to support their families". The female students displayed a more emotional and reflective experience, with a strong focus on patient care, whereas male students identified more with individual aspects of learning and the organization and quality of the units. Both male and female students experienced intense emotions, improved their learning in complex environments and acquired attitudes linked to the humanization of care. However, the experience of these clinical rotations was different between female and male students.

New Graduate Registered Nurses and the Spectrum of Comfort in Clinical Practice

The comfort zone is where a person consistently performs his or her role in an affective state devoid of anxiety and without a feeling of risk. This study challenges the notion of a singular comfort zone and suggests that a spectrum of comfort is a more accurate reflection of the new graduate experience. A grounded theory methodology was used to identify and explain the spectrum of comfort considerations helpful to nine new graduates amid their transition to professional practice. Emerging from the data were themes that encompassed both the positive and negative regions of the spectrum of comfort. Negative themes were: Feeling Abandoned, Sometimes I Get Frightened, and Feeling Betrayed-Catching Hold. The more positive themes were: Moderation of Emotions, and Letting Go. Each of these themes requires an appropriate response from new graduates and experienced staff. The spectrum of comfort model and practical considerations of support could accomplish this. [J Contin Educ Nurs. 2019;50(12):563-571.].

New graduate registered nurses' experiences with psychological safety

AIM

The purpose of this study was to gain insight into new graduate registered nurses' experiences with psychological safety.

BACKGROUND

Organizational learning allows acute care hospitals to consistently provide high-quality patient care. Psychological safety is critical for organizational learning. New graduate nurses in particular need to feel psychologically safe as they transition into professional nursing practice. Understanding new graduate registered nurses' experiences of psychological safety can guide leaders and others to create work environments that foster psychological safety and organizational learning.

METHOD

Semi-structured interviews were conducted with 13 newly graduated registered nurses working in inpatient hospital settings. Interviews were analyzed using thematic analysis.

RESULTS

Four primary themes featured prominently in the new graduate nurses' experiences of psychological safety: building credibility, making personal connections, feeling supported and seeking safety.

CONCLUSION

Understanding these themes will help nursing education programmes, nurse managers, nurse colleagues and new graduate registered nurses foster psychological safety and create environments conducive to organisational learning.

IMPLICATIONS FOR NURSING MANAGEMENT

All members of the health care team involved in the new graduate registered nurses' transition to practice have a role in fostering psychological safety. Additional research is needed to better understand psychological safety and how to foster it.

The Impact of Critical Reflective Inquiry Education on Experienced Nurses' Insights Into Practice

Successful succession planning necessitates use of innovative strategies to encourage and support knowledge recovery and transfer. This quality improvement project evaluated the impact of a critical reflective inquiry workshop on experienced nurses' insights into practice. Nurses assessed written clinical narratives using the Critical Reflective Inquiry Assessment Tool before and after the workshop. Guided reflection led by nursing professional development practitioners fostered insight into practice, which is an essential step in supporting knowledge transfer to 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.

Narratives in student nurses' knowledge development: A hermeneutical research study

BACKGROUND

Knowledge development, and how student nurses learn to be nurses, is essential in nurse education and has implications for quality of care. There is a lack of research concerning how student nurses' knowledge development is expressed through narratives and how they deal with challenges in patient situations in professional learning.

OBJECTIVES

To clarify the usefulness of narratives in student nurses' knowledge development and the narratives implications for learning in clinical training.

DESIGN AND METHODS

The study has a qualitative design with field methodology. Data consisted of observations, interviews, and fieldnotes. The data was analysed, and narratives were developed using Gadamer's hermeneutical circle.

PARTICIPANTS AND SETTINGS

Seven first- and second-year student nurses from a bachelor programme were closely followed in different patient situations during their eight weeks of clinical studies in nursing homes.

RESULTS

In a sample narrative, a student nurse explained how she reflected on her actions and decisions made when she shielded a patient who was in a difficult situation.

CONCLUSION

Narratives are useful for the development of student nurses' knowledge in clinical training. Student nurses' decisions and actions in the patient situation are made evident through narratives. Nursing educators and student nurses awareness of the relevance of this knowledge for understanding student nurses learning processes is of importance in professional education. Nursing educators should be more open minded to narratives as a starting point for reflection. Increased use of narratives in professional education will contribute to development of knowledge so that student nurses can manage to face patient situations as long as the situation themselves demands. Areas for further studies are other professional educations, for examples, doctor, physiotherapist, and occupational therapist.

Experiences of registered nurses in a general practice-based new graduate program: a qualitative study

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs.