A bridge over troubled water? - Exploring learning processes in a transition program with newly graduated nurses

Reflection Supports Newly Graduated Nurses' Professional Development When Transitioning Into Practice

AIM

To describe newly graduated nurses' experiences of reflection as a support for professional development during the initial months of their transition while caring for patients in a hospital setting.

DESIGN

A qualitative descriptive design.

METHODS

Four focus groups with 20 newly graduated nurses participating in a professional development programme at aregion in Sweden were conducted in 2023. The data were analysed using qualitative content analysis.

FINDINGS

The analysis identified one main category: Reflection supports newly graduated nurses' professional development during their transition. This main category includes three generic categories: (1) Reflection with peers in a regularly structured dialogue group strengthens the professional role; (2) reflection with experienced healthcare instructors in learning activities enhances the mastery of care tasks; and (3) reflection with experienced colleagues in the workplace enhances task performance. Structured reflection in dialogue groups and interactive learning activities within the Professional Development Programme facilitated deeper reflections on caring experiences.

CONCLUSIONS

Newly graduated nurses reported that regularly structured reflection, adequate space, and established trust were essential to their professional development. While the professional development programme provided opportunities, variations in the workplace environment led to unequal conditions for reflective practice.

IMPLICATIONS FOR THE PROFESSION

Addressing the need for reflection among newly graduated nurses is crucial for organisations to facilitate their transition. Establishing structures for reflection on caring experiences within introduction programmes can support their professional development.

IMPACT

Reflective practice in complex and challenging hospital settings can support the professional development of newly graduated nurses.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) was adhered to.

PATIENT OR PUBLIC CONTRIBUTIONS

No patient or public contributions.

Immersive solutions: South African community service nurses' perspectives on virtual reality potential in hypertension management

Introduction

With the rapid development of information technology globally and the scarcity of educators in higher education institutions, educational reforms are crucial to prepare students for an advancing and complex work environment. Virtual reality (VR) makes education widely available as it bridges the gap between students and educators, as educators and students enter an immersive world where educators can guide students.

Aim

The researchers' aim for this study was to explore community service nurses' (CSN's) experiences with a VR prototype when managing a hypertensive patient.

Method

The study comprised nine CSN with varied knowledge, skills, experiences, and who have been allocated to certain disciplines within a public hospital. The study was split into three phases: phase one, focus group and individual interviews were used to gain an understanding of the CSN's current knowledge and experiences regarding the assessment and implementation of nursing interventions used in the management of hypertensive patients. In the second phase, participants were exposed to the VR environment, where they were prompted by the programmed patient avatar to perform several nursing diagnostic procedures and interpret the clinical data provided in order to formulate a nursing diagnosis. During the third phase, the researchers conducted focus groups and individual interviews to acquire and comprehend the participants experiences regarding their interaction with the VR prototype and describe the benefits and drawbacks of the prototype they encountered.

Results

Constructive feedback and recommendations were provided by participants regarding the VR program's interactiveness and the accuracy of diagnostic tests. Participants claimed the experience was enjoyable, and based on the researchers' observations, the VR program stimulated critical thinking as well as clinical reasoning as intended. Their feedback was used to alter the VR prototype before the main study's commencement.

A programme theory for a transition programme for novice nurses in emergency departments: A realist review

AIMS

To develop a programme theory for a transition programme for novice nurses working in emergency departments.

DESIGN

A realist review was conducted, guided by the Realist and Meta-narrative Evidence Synthesis-Evolving Standards publication standards.

DATA SOURCES

PubMed, CINAHL, Web of Science, Scopus, and the Wiley Online Library.

REVIEW METHODS

A realist review methodology was used to consider the contexts, mechanisms, and outcomes of transition programmes implemented in emergency departments. The Population, Concept, Context framework was used to develop a search strategy. Four reviewers independently screened the records using Rayyan. Conflicting decisions were evaluated against the inclusion and exclusion criteria to reach a consensus. The data were extracted literatim to a Google form and exported in an Excel spreadsheet. The frequencies for categorical data were calculated, and the textual data were thematically analysed. The theories supporting the programme theory were identified using a Behaviour of Interest, Health context, Exclusions and Models or Theories (BeHeMoth) search.

RESULTS

Eleven reports of the 1275 records met the inclusion criteria. Three contextual factors influencing the transition programme, namely, the characteristics of the novice nurse, interpersonal relationships, and the emergency department, were identified. Mechanisms were classified as resources, including programme champions, learning and teaching activities, and responses to the programme. The primary outcomes included novice nurses and emergency departments. Secondary outcomes included the establishment of educational support structures. The final programme theory was developed based on the review results and supporting theories.

CONCLUSION

Novice nurses with specific characteristics will most likely become proficient in a well-equipped and well-maintained emergency department when sufficient support is offered while maintaining healthy interpersonal relationships. A transition programme that is provided by experts and codesigned is one way of supporting novice nurses.

Development and psychometric testing of the modeling scale for novice nurses: a cross-sectional survey design

BACKGROUND

Modeling is the learning of new patterns of behavior by observers through observation. In order for novice nurses to learn effectively in a busy, multi-tasking clinical environment, they need a learning strategy that is integrated into their daily work. Modeling is a necessary learning strategy for nurses because they learn skills, knowledge, and attitudes by observing senior nurses in action. In nursing, it is important to learn skills, knowledge, and attitudes by observing the behavior of senior colleagues. However, previous studies have shown that there are situations in which modeling is not done smoothly. Therefore, in this study, we decided to develop a modeling self-assessment scale to assist novice nurses in modeling.

METHODS

1,457 novice nurses from a random sample of 103 hospitals in Japan were selected, of which 337 novice nurses were surveyed from November 2019 to January 2020 by anonymous questionnaire. The questionnaire consisted of the draft Modeling Scale for Novice Nurses, The Scale Measuring a Sense of Generalized Self-Efficacy and a simplified version of the Scale of Self-Regulated Learning Strategy for Nurses for review of criteria-related relevance to the Modeling Scale for Novice Nurses, and personal background. Factor analysis was used for analysis, and correlation coefficients were calculated for criterion-related validity. For stability, the number of intraclass correlation coefficients were calculated for consenting subjects by retesting method 3 weeks after their responses.

RESULTS

The demographics of the participants were 316 women and 21 men, with a mean age of 22.7 ± 1.8 years. Item and factor analyses yielded 21 items with four subscales. Cronbach's α coefficient for the 21 items was 0.930. The correlation coefficients for the Modeling Scale for Novice Nurses and the Scale of Self-Regulated Learning Strategy for Nurses ranged from 0.266 to 0.480. In the retest method, the intraclass correlation coefficient ranged from 0.771 to 0.786.

CONCLUSIONS

The Modeling Scale for Novice Nurses can be used to obtain novice nurses' self-assessment of modeling and to assist novice nurses in modeling smoothly.

Program components, impact, and duration of implementing a new nurse orientation program in hospital contexts: A scoping review

Background

Orientation programs for new nurses play an essential role in preparing them for challenges in clinical practice. Different countries have applied varying program components and durations in organizing these programs.

Objectives

To explore the program components, impact, and duration of the orientation programs for new graduate nurses in hospital care settings.

Method

We gathered information from studies conducted in various countries. Searches were conducted on databases including PubMed, Sage Journal, ScienceDirect, EBSCO, and Wiley, with secondary searches from 2018 to 2023 using Arkey and O'Malley's Review Scoping Framework. The inclusion criteria comprised studies with primary data, both qualitative and quantitative, focusing on new nurses undergoing orientation programs in hospitals.

Results

Of the 989 articles screened, 14 were included. Methods identified included providing hands-on experience, sharing information, reflecting on work experiences, and developing technical skills. Significant findings encompassed increased competence, knowledge, confidence, and satisfaction, as well as professional development and positive organizational impacts. The duration of orientation programs ranged from 2 weeks to 2 years, depending on the program type and new graduate nurse needs.

Conclusion

This scoping review elucidates program components, impact, and duration of new nurse orientation programs in hospitals, providing valuable insights for hospital management in designing and developing improved programs.

Tweetable abstract

Exploring program components, impact, and duration of hopitals new graduate nurse orientation programs, revealing insights to enhance patient care and nursing practice@Ns_Ernawaty.

Interventions that support novice nurses' transition into practice: A realist review

BACKGROUND

Many transition-to-practice programs have been developed to support novice nurses during their first years into practice. These programs report improvements in retention, wellbeing and clinical competence, but the driving mechanisms of these interventions remain largely unclear.

OBJECTIVE

To identify how transition-to-practice programs for novice nurses work and in what contexts they work successfully.

METHODS

A realist review was conducted. Eligibility criteria included intervention studies aimed at novice nurses in their first two years of practice that reported outcomes on organizational or individual nurse level. The underlying theory of included transition-to-practice programs was extracted, and relevant contextual factors, mechanisms and outcomes were explored and synthesized into context-mechanism-outcome (CMO) configurations. The search was limited to studies between 2000 and 2023.

RESULTS

A total of 32 studies were included, evaluating 30 different transition-to-practice programs with a wide range of intervention components including stress management, clinical education, professional and peer support, and ward rotations. Transition-to-practice programs were often designed without a theoretical foundation. Driving mechanisms behind the programs pertained to psychological, professional, and social development. Contextual factors that activated the mechanisms were enabling conditions for mentors and novice nurses, selection and motivation of novice nurses and organizational culture.

CONCLUSIONS

Current transition-to-practice programs primarily focus on the individual and professional development of nurses. However, transition to practice can benefit from a systemic approach that includes development initiatives on the organizational level.

REGISTRATION

PROSPERO ID CRD42021268080, August 15, 2021.

TWEETABLE ABSTRACT

Context and mechanisms determine successful implementation of transition to practice programs for novice nurses. @transitiontopractice @nurseworkforce.

Commitment and efforts to maintain mentoring: Nurse managers' perceptions of structuring mentoring provision for new nurses in a hospital setting

AIM

The aim of the present study was to describe nurse managers' perceptions of the provision of mentoring for newly graduated registered nurses (NGRNs) and its contribution to the work environment in a hospital setting.

BACKGROUND

Nurse managers are responsible for the work environment and for supporting the staff's professional development, which includes giving NGRNs organizational support during their introduction to the workplace. Mentorship is one common way to provide support, but there is a lack of knowledge about how nurse managers view this support.

DESIGN/METHOD

This was a qualitative descriptive study, using a semi-structured interview guide. Fifteen individual interviews with nurse managers were performed in hospital settings. The interview transcripts were analysed using qualitative content analysis. The COREQ guidelines and checklist were used.

RESULTS

The results describe the nurse managers' perceptions of the provision of mentoring in three themes: Ensuring and sustaining mentoring for new nurses' needs is a struggle in the harsh reality of healthcare, Identifying mentors who are willing and possess the necessary competence for the assignment and Promoting a secure and attractive workplace by mentoring new nurses.

CONCLUSIONS

Our study confirms that nurse managers are important in the provision of mentoring for NGRNs' learning and professional development. Mentoring has a positive spillover effect on the entire unit as a sustainable approach to securing and improving the work environment. Our study also identifies challenges for nurse managers to structure mentoring provision.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study highlights the importance of investment in mentoring for the NGRNs' professional development and for patient care. Support is needed from the top level of the organization, but how mentoring should be structured and facilitated needs to be investigated further.

Program coordinators' perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study

PURPOSE

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators' perspectives on implementing a transition program for newly graduated nurses.

DESIGN/METHODOLOGY/APPROACH

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

FINDINGS

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

ORIGINALITY/VALUE

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

The impact of transition programs on well-being, experiences of work environment and turnover intentionamong early career hospital nurses

BACKGROUND

Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups.

OBJECTIVE

To explore the long-term impact of having attended a transition program on the nurses' experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables.

METHODS

A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups.

RESULTS

The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small.

CONCLUSION

Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

Prepared to learn but unprepared for work: A cross sectional survey study exploring the preparedness, challenges, and needs of newly graduated nurses entering a hospital-based transition program

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

BACKGROUND

Previous research has raised questions about new graduate nurses' (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs' expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

DESIGN

A cross-sectional survey design was used.

METHOD

NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

RESULTS

Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit. The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses' readiness for clinical work, the challenges they perceive, and their needs for learning and support.

The Theory-Practice Gap in Nursing Education During the Pandemic Period from the Perspective of Stakeholders: A Qualitative Study

Objective: The purpose of this study was to understand the experience of theoretical and practical nursing education carried out by distance education during the COVID-19 pandemic and the theory-practice gap in nursing education in Turkey. Methods: This qualitative study used a descriptive qualitative study. This research was conducted with nursing lecturers and students from two universities in two different geographical regions. Lecturers and undergraduate students participated in the research. The data for the research were collected using the online Zoom program during four focus-group discussions. Results: Three main themes emerged for the categories of theoretical and practical education emerged during the study: strong structural conditions (technological integration and accessibility) both strong and weak structural conditions (asynchronous participation and changing comfort levels/routines) and weak structural conditions (cold contact and inequality of opportunity). Conclusion: This study revealed the strengths and weaknesses in the experience of distance nursing education and will guide future planning of nursing education programs and clinical fields.

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.

Nursing students' experience with clinical placement in nursing homes: a focus group study

Background

A renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach.

Methods

To explore first-year nursing students’ placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students’ placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR).

Results

The analysis describes five themes relating to first-year students’ placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role.

Conclusions

The research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student’s growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students’ clinical education in nursing homes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00690-4.