Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme

Exploring Well-Being Disparities: A Comparative Analysis of Urban and Rural Clinicians Using the NIOSH Worker Well-Being Questionnaire

BACKGROUND

Clinician well-being is crucial to the healthcare system, particularly during the COVID-19 pandemic, which intensified psychological distress among clinicians. This study examines well-being disparities between rural and urban clinicians using the NIOSH Worker Well-Being Questionnaire (WellBQ).

METHODS

A cross-sectional survey was conducted with 222 clinicians from one urban and three rural hospitals in North Carolina between September and December 2022. The WellBQ assessed well-being across five domains. Data analysis identified concerning thresholds based on positive and negative responses, with discrepancies resolved through independent reviews and focus group validation.

FINDINGS

In the work evaluation and experience domain, rural hospitals reported concerns with time paucity and work overload, while urban hospitals focused on work-related fatigue and job engagement. Rural hospitals noted issues with job benefits, health programs, and schedule flexibility, whereas urban hospitals emphasized the lack of supportive work culture and management trust. Both settings reported concerns in the physical environment and safety climate domain, including sexual harassment, physical violence, and bullying. Health status concerns in rural hospitals included overall stress and poor mental health, while urban hospitals highlighted chronic health conditions and risky drinking.

CONCLUSION

This study identified significant well-being disparities between rural and urban clinicians, with urban hospitals showing higher concerning thresholds. Future research should refine these thresholds, explore workplace violence causes, and assess long-term impacts on clinician well-being.Applications to Practice:This study reveals significant well-being disparities between rural and urban clinicians, emphasizing the need for tailored occupational health interventions.

South Korean Nurse Residency Program for New Graduates: A Posttest Study

BACKGROUND

Turnover rates among newly graduated nurses are high, increasing the workload for other nurses and hampering organizational productivity. This study investigates the effects of a nurse residency program (NRP), examining clinical competence, job satisfaction, organizational socialization, turnover intention, and turnover rates.

METHOD

This study was conducted among newly employed graduate nurses in South Korea. Participants (N = 167) included nurses with less than 6 months of experience (NRP group, n = 52; control group, n = 115). The current results were measured 1 year after initiation of the NRP.

RESULTS

The NRP group showed significantly lower turnover intention and turnover rates and substantially better clinical competence, job satisfaction, and organizational socialization.

CONCLUSION

Even when applied in the unique South Korean cultural and medical context, the NRP improved job performance and satisfaction as well as organizational socialization and reduced turnover rates and turnover intention among new nurses. Therefore, a systematized NRP should be actively used when new nurses are onboarded. [J Contin Educ Nurs. 2024;55(8):393-397.].

Working From Within: The Rural Community Participatory Design Framework

OBJECTIVE

This article describes the development of the rural community-based participatory design framework to guide healthcare design teams in their integration of rural community and clinical voice during the planning, design, and construction of a healthcare facility.

BACKGROUND

Rural communities are facing an alarming rate of healthcare facility closures, provider shortages, and dwindling resources, which are negatively impacting population health outcomes. A prioritized focus on rural care access and delivery requires design teams to have a deeper understanding of the contextual considerations necessary for a successful healthcare facility project, made possible through engagement and partnership with rural dwelling community members and healthcare teams.

METHOD

The rural community participatory design framework is adapted from the rural participatory research model, selected due to its capture of key concepts and characteristics of rural communities. Underpinning theories included rural nursing theory and theory of the built environment.

RESULTS

The framework encompasses healthcare facility project phases, key translational concepts, and common traits across rural communities and cultures. As a middle-range theoretical framework, it is being tested in a current healthcare project with a Critical Access Hospital in Montana to facilitate design team and stakeholder collaboration.

CONCLUSION

The rural community participatory design framework may be utilized by design teams as a means of familiarization with rural cultures, norms, values, and critical needs, which relate to meaningful design. The framework further enables design teams to critically appraise best practices of stakeholder engagement throughout the project lifecycle.

The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review

AIMS AND OBJECTIVES

This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and stress and enhance new graduate nurses' resilience during the transition from education to clinical practice.

BACKGROUND

Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown.

DESIGN

A scoping review of the current literature (with no date limit) using the PRISMA-ScR checklist for reporting scoping reviews was utilised.

METHOD

Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched.

RESULTS

This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students.

CONCLUSION

The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying.

RELEVANCE TO CLINICAL PRACTICE

Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.

Assessing the Impact of Community Factors on Acute Care Nurses’ Job Satisfaction and Turnover Intention

Background

Community factors may affect nurses’ job behavior and decision making. There is a gap in the literature regarding the impact of community satisfaction, family ties, and community preferences on acute care nurses’ turnover intention and job satisfaction. Furthermore, no studies have examined the differences in community satisfaction, community preferences, and family ties among nurses working in rural and urban settings.

Purpose

To identify the impact of family ties, community satisfaction, and community preferences on turnover intention and job satisfaction among acute care nurses working in Ontario's urban and rural areas.

Methods

Descriptive correlational survey design was used in this study. A targeted stratified sampling technique was used to recruit acute care nurses working in Ontario's urban and rural areas (N = 349) between May 2019 and July 2019. Dillman's approach was used to guide data collection. Parametric and non-parametric tests were used for data analysis.

Results

A significant association was found between working settings and community preferences. A statistically significant positive relationship between community satisfaction and nurses’ job satisfaction was identified. Furthermore, community satisfaction had a negative impact on turnover intention. Neither community preference nor family ties were significantly associated with turnover intention or job satisfaction.

Conclusion

The study suggests that community satisfaction can influence important nurse work-related outcomes. Future studies should replicate and validate these results in different contexts and cultures. Retaining nurses may be difficult if they are not satisfied with their communities.

Experiences of Western Australian rural nursing graduates: A mixed method analysis

AIMS AND OBJECTIVES

To determine whether the current rural graduate programmes in Western Australia adequately support new graduate nurses transitioning into practice.

BACKGROUND

Graduate nurse's transition to employment is a time of significant change and challenge, often resulting in periods of transition shock. These challenges are magnified in rural areas where graduates have to relocate to commence their career with limited rural nursing experience. Graduate programmes were developed to smooth the transition for university trained bachelor's degree registered nurses into the workforce. Supportive graduate nursing programmes are essential for enabling transition to practice and reduce attrition rates.

DESIGN

Longitudinal convergent mixed method parallel design was informed by Duchscher's transition stage model.

METHOD

Thematic analysis was applied to all interviews. COREQ checklist was completed. Descriptive statistics and content analysis were used to analyse the survey responses.

RESULTS

New graduates cycled through both transition shock and honeymoon periods on commencement of employment, reporting high levels of satisfaction in simultaneity with signs of transition shock. Satisfaction dropped within 7 months indicating a transition crisis before an adjustment period occurred at the end of their graduate year. Limited resources were highlighted as obstacles to providing adequate support to rural graduate nurses.

CONCLUSION

The honeymoon stage of transition co-existed with transition shock at the commencement of graduate programmes, which may obscure the need for continuing adequate support. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programmes. Graduate programmes need to be structured but flexible to allow for individual differences in graduates' and clinical contexts.

RELEVANCE TO CLINICAL PRACTICE

Structured but flexible graduate programmes allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their graduate year to assist and overcome the transition crisis stage. Education of nurses undertaking the preceptor role is required to deliver adequate support to graduate nurses and decrease transition shock.

Lived experiences of new nurse graduates in critical access hospitals

BACKGROUND

Critical access hospitals (CAHs) may have less support for new hires than larger institutions, and are at risk for recruitment and retention issues.

PURPOSE

The purpose of this descriptive, phenomenological study was to explore the lived experiences of new nurse graduates in the first year of employment in CAHs.

METHODS

Thirteen first-year critical access hospital nurses were interviewed, representing 3 midwestern states.

RESULTS

Six themes were identified using Colaizzi's (1978) seven-step process for analysis: (1) always a professional, (2) personal connections, (3) pride in work and community, (4) always on your toes, (5) everyone works as a team, and (6) essential preparation experiences.

CONCLUSIONS

Most study participants identified "always a professional" as a major part of their identity as nurses and within the community. This study could assist leaders in both nursing education and rural hospital settings to better understand the needs of new nurses as they launch their nursing careers in critical access hospitals.

Predictors and outcomes of work-family conflict among nurses

BACKGROUND

Work-family conflict, an issue important to nursing management, has been examined extensively worldwide. With an increasing number of nurses leaving and intending to leave the country, and considering the traditional family arrangement, it is increasingly relevant to examine the precursors and outcomes of work-family conflict among Filipino nurses.

AIM

To identify the predictors of work-family conflict and its relationship to Filipino nurses' work outcomes and perceived quality of care.

METHODS

A descriptive research design was utilized to collect data from one thousand one hundred (n = 1010) registered nurses with more than three months of experience working in the hospital using the Work-Family Conflict Scale, Job Satisfaction Index, Perceived Stress Scale, the two single-item measures of turnover intention, and a single-item measure of care quality.

RESULTS

Filipino nurses experience moderate levels of work-family conflict. Nurses' age, education, facility size, and hospital location predicted work-family conflict. Work-family predicted job satisfaction, job stress, intention to leave the organization, and perceived quality of care.

CONCLUSIONS

In accordance with international studies, Filipino nurses experience significant levels of work-family conflict. Addressing work-family conflict may result in improved work outcomes and increased care quality rating.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Organizational measures to address work-family conflict in nurses should take into account the different predictors identified, particularly those that are modifiable. Nurses' work outcomes and care quality can be improved by employing empirically based measures to effectively address work-family conflict.

New graduate nurses' clinical competence: A mixed methods systematic review

AIM

To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings.

DESIGN

Mixed methods systematic review.

DATA SOURCES

The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019.

REVIEW METHODS

Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion.

RESULTS

About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0-6 months, but findings are inconsistent from 6-12 months.

CONCLUSION

There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor.

IMPACT

No recent reviews comprehensively synthesized the findings from new graduate nurses' clinical competence. This review has found that new graduate nurses' competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

A National Survey of RN-to-BSN Programs: Are They Reaching Rural Students?

BACKGROUND

Increased representation of Bachelor of Science in Nursing (BSN)-prepared nurses improves health and reduces costs. Fewer rural U.S. nurses have BSN degrees compared with the national average. RN-to-BSN programs provide an opportunity to increase the number of BSN-prepared rural nurses. However, the number of these programs targeting rural students is unknown.

METHOD

Directors of RN-to-BSN programs were surveyed regarding program characteristics and efforts to target rural learners. Using mail and online return options, the response rate was 31.3%.

RESULTS

Only 38% of programs targeted rural RNs for recruitment. Supports for rural student recruitment and retention, including partnerships with community colleges, rural clinical placements, and online offerings, were limited in number and/or scope.

CONCLUSION

RN-to-BSN programs with the capacity to recruit and retain rural learners may help increase the number of BSN-prepared rural nurses. Increased collaboration among stakeholders will support rural nurses in continuing their education. [J Nurs Educ. 2020;59(10):557-565.].

Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce

BACKGROUND

Multiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas.

PURPOSE

Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.

METHODS

Data were obtained from the 2011-2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18-64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings.

RESULTS

Urban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001).

CONCLUSIONS

Strategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.

Transition support for new graduate nurses to rural and remote practice: A scoping review

BACKGROUND

New graduate nurses undertaking transition to practice encounter enormous challenges in their first year, and this is expounded in rural and remote locations. In rural and remote settings where geographical isolation and inadequate resources impact health care delivery, there is a perceived shortage of support systems to assist new graduate nurses to transition smoothly, with reported negative effects for all staff and on recruitment and retention.

OBJECTIVES

To investigate what transition support was reported for new graduate nurses to function effectively in rural and remote settings.

DESIGN

A study protocol was developed using principles for scoping reviews that have been developed over the past fifteen years.

DATA SOURCES

CINAHL, Medline, Proquest, Embase, Informit, PubMed, and Science Direct were systematically searched according to a predetermined search strategy.

REVIEW METHODS

Search terms included New Graduate AND Rural OR Remote AND Education. Studies were selected according to an inclusion and exclusion criteria. Three reviewers were involved in independent screening of articles. The degree of agreement for an article to be included was based on a Kappa score calculation for inter-rater reliability.

RESULTS

Of the 662 articles searched, 13 met the inclusion criteria and their findings synthesised to form this review. Three overarching themes (and a number of subthemes) were identified within the context of rural and remote nursing workforce development, and included: new graduates' support needs, multifaceted support strategies and recruitment and retention strategies.

CONCLUSIONS

Challenges faced by new graduate nurses when transitioning to practice are exacerbated in most rural and remote settings due to resourcing, lack of structured support programs, lack of training for support staff to mentor and give feedback and this impacts on recruitment and retention as well. Structured, well supported transition programs that provide flexible support are urgently required in these settings.

Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy

OBJECTIVE

The purpose was to compare nurse education, patient-to-nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality.

DESIGN

Cross-sectional, comparative, and descriptive.

SAMPLE

The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania.

MEASUREMENT

Data collected from large random samples from the 2005-2008 Multi-State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005-2006 American Hospital Association data. Rural-Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample.

RESULTS

Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient-to-registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals.

CONCLUSION

Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies.

Perceived needs and coping resources of newly hired nurses

Objective:

Newly hired nurses who do not transition well often leave their first nursing position or nursing prematurely, at great cost to themselves, the profession, hiring organizations and patients. The purpose of this secondary analysis study was to better understand the transition experience of new graduate nurses and experienced nurses as they moved to a new setting in nursing, and the preceptor’s role in that transition.

Methods:

Schlossberg’s Transition Theory provided the framework for the secondary analysis of a large qualitative data set that were collected from 118 newly hired nurses who were predominantly female and Caucasian with the majority being under the age of 30 years and having less than 1-year experience. The data available for secondary analysis included all transcripts from the original study.

Results:

Two main themes were identified: Institutional Support and Sense of Self.

Discussion:

Preceptors are critical early in the transition and the newly hired nurse continues to look for support beyond the first year of the transition. Hospitals should consider implementing transition to practice programs that support the newly hired nurse, to include those with prior experience, throughout the first year of transition and should also consider a mentorship program of support after the first year.

Fall Rates in Urban and Rural Nursing Units: Does Location Matter?

Patient falls remain a leading adverse event in hospitals. In a study of 65 rural hospitals with 222 nursing units and 560 urban hospitals with 4274 nursing units, we found that geographic region, unit type, and nurse staffing, education, experience, and outcomes were associated with fall rates. Implications include specific attention to fall prevention in rehabilitation units, creating better work environments that promote nurse retention, and provide RN-BSN educational opportunities.

The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety: An Integrative Review

Stronger evidence on the value of new graduate nurse transition programs is needed to justify the cost and warrant expansion of these programs to more health systems. The aim of this integrative review was to critically analyze published research on the relationship between new graduate nurse transition programs and patient safety outcomes. Limited evidence was found on actual safety improvement; rather, transition programs have predominately measured the development of competency as a process outcome variable for improving patient safety. A systems model is proposed to guide future research examining structure, process, and outcome variables, linking transition programs with patient outcomes.

The academic-practice gap: Strategies for an enduring problem

The academic-practice gap in nursing is well documented. Academe is criticized for producing nurses insufficiently prepared to fully participate in patient care. Practice settings are criticized for having unrealistic expectations of new graduates. This article is based on a review of the literature and an exploration of contemporary practices used to bridge academic and practice partnerships. Differences in outcome expectations for new graduates between academe and practice are outlined and consequences of the gap for new graduates, patients, and employers are discussed. Five specific strategies to address the gap are discussed, with the primary realm and responsibility for two falling to education, one to practice, and two to both. Strategies discussed include increased use of simulated learning in nursing education; disruptive innovations in education that promote learner-centered active learning; extended orientation/Transition to Practice Programs for new graduates; dedicated education units; and academic service partnerships. Current literature suggests the viewpoints of academic and practice leaders continue to appear divergent. Closing the gap will require a dedicated and coordinated response from both academe and clinical practice.

Newly Licensed RN Retention: Hospital and Nurse Characteristics

OBJECTIVES

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence.

METHODS

A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience.

RESULTS

The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay.

CONCLUSION

Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Integrating Retired Registered Nurses Into a New Graduate Orientation Program

PURPOSE

The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area.

DESCRIPTION OF PROJECT

All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues.

OUTCOME

All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA.

CONCLUSION

Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.

The quality of work life of registered nurses in Canada and the United States: a comprehensive literature review

BACKGROUND

Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses.

OBJECTIVE

The aim of this paper was to perform a comprehensive literature review on nurses' quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada.

METHODS

Using publications from 2004-2014, contributing factors to American and Canadian nurses' QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis.

RESULTS

Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses' quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation.

CONCLUSIONS

This review's findings support the importance of QWL as an indicator of nurses' broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.