An integrative review of rural and remote nursing graduate programmes and experiences of nursing graduates

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.

Gratitude interventions to improve wellbeing and resilience of graduate nurses transitioning to practice: A scoping review

Background

New graduate nurses are the nursing cohort at greatest risk for turnover and attrition in every context internationally. This has possibly been heightened during the COVID-19 pandemic. Workplace conditions significantly impact nursing turnover; however, interventions under the positive psychology umbrella may have a mediating impact on the intention to leave. New graduate nurses are generally challenged most in their first three years of clinical practice, and the need for support to transition is widely accepted. Gratitude practice has been reported to improve individual control and resilient response to setbacks and, therefore, is of interest in testing if this intervention can impact turnover intention in the workforce.

Objective

To report on a scoping review undertaken to identify whether 'gratitude practice' as an intervention had the potential to improve new graduate nurses' wellbeing and resilience.

Methods

Arksey and O'Malley's scoping review approach. Primary research papers of any methodology, published in English between January 2010 and July 2022 were included. Literature was sourced from seven databases, including CINAHL PLUS, ERIC, MEDLINE, Professional Development Collection, APA PsychInfo, APA PsychArticles, and Psychological and Behavioural Sciences Collection.

Results

We identified 130 records, of which we selected 35 for inclusion. A large range of interventions were identified; most had some form of writing, journaling, or diarising. The next most common intervention was teaching gratitude strategies via workshops, and many interventions had some form of list or activity trigger for participants to complete. Five studies had complex combined interventions, while the rest were simple, easily reproducible interventions. Interventions were delivered both face-to-face or asynchronously, with some being online only and others sent out as a 'kit' for participants to work through.

Conclusion

Our review of existing literature shows a significant gap in research on gratitude practice and its impact on nursing populations. To ensure robust future studies, we suggest defining concepts clearly and selecting outcome measures and tools that are not closely related. Intervention design may not be as important as the choice of measures and tools to measure outcomes.

Transition status and influencing factors of newly graduated nurses: A descriptive survey design

AIMS

To assess the transition status of newly graduated nurses in China and identify its influencing factors.

BACKGROUND

Newly graduated nurses are the indispensable part of nursing human resource. The successful transition of into clinical work is crucial for their future career development. However, the transition status of new nurses in China remains inadequately explored.

DESIGN

A descriptive survey design was employed in this study.

METHODS

From October 2022 to January 2023, 1261 newly graduated nurses were surveyed online with the Transition Status Scale for Newly Graduated Nurses. Description statistical analysis was adopted to evaluate the transition status of new nurses. Independent-samples t-test, Analysis of Variance and Multiple Regression Analysis was used to explore the influencing factors of the transition status.

RESULTS

The total mean score of Transition Status Scale for Newly Graduated Nurses was 4.00 (SD=0.61). Competence for nursing work (Mean=4.20; SD=0.57) was rated the highest among the five dimensions of the scale, while the dimension of balance between work and life (Mean=3.65; SD=0.89) was rated the lowest. Mentored by senior nurses, night shift, attribute of working hospital, educational background, interned in the same department, tertiary general hospital, reasons for choosing nursing and working time can affect the transition status of new nurses, accounting for 17.9% of the variance in transition status (R²= 0.179, P＜0.001).

CONCLUSION

The transition status of newly graduated nurses in China is at a relatively high level, especially in the dimension of competence for nursing work. However, newly graduated nurses are in a relatively poor status of work-life balance. Nurse educators and managers need to pay more attention to the transitional training of highly educated nursing talents and the optimization of clinical transition training programs to prevent talent loss. Experienced tutors should be allocated to provide guidance for newly graduated nurses.

The threshold of rural placement frequency and duration: A repeated cross-sectional study examining rural career aspirations among student nurses

AIM

This study aimed to explore what changes rural placement had on the perceptions of nursing students and the impact of placement frequency and duration on student considerations for rural practice.

BACKGROUND

A strong rural healthcare workforce is a global concern and has led countries to look for creative ways to address this challenge. One approach is to train more health professionals, however, nursing students who grew up or lived in metropolitan or urbanised areas are suggested to be less inclined to pursue a rural career. As such it is posited that recurrent exposure to rural settings may exert a positive impact on future intention for rural practice. However, there is a need to explore the specific thresholds related to both the frequency and duration of rural placement exposure, as well as the cumulative impact multiple rural placements may have on the intention to engage in rural practice.

DESIGN

A repeated cross-sectional design.

METHODS

All nursing students from an Australian regional university were invited to complete an online questionnaire between 2019 and 2023. Demographic and placement specific questions were included. A modified version of the Nursing Community Apgar tool also measured the importance of key variables in rural career decision-making. Data were analysed using independent sample t-tests and one-way ANOVAs. Significance was determined at two-tailed p≤.05.

RESULTS

Among the 835 respondents (response rate 15.4%), the average number and duration of rural placements was 2.45 placements and 3.01 weeks respectively. Rural placements did not have an impact on students who resided rurally or regionally. However, among metropolitan students who had experienced more than three rural placements, or more than sixteen cumulative weeks of placement, were significantly more likely to consider rural employment. Greater number of rural placements and longer cumulative duration had the greatest impact.

CONCLUSION

Issues related to the nursing rural workforce are dynamic and complex. Understanding the unique drivers that improve the rural experiences among students, particularly metropolitan students, can have an impact on decision-making to pursue employment in rural environments. Importantly, whilst professional and clinical motivation and experiences are influential factors, the socialisation, environment and community features are essential elements that influence students' decisions to pursue a career in rural practice. Undertaking a nuanced approach that facilitates rural practice understanding among students may help shape future employment decision-making.

Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision

BACKGROUND

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion.

METHODS

A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified.

RESULTS

Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making.

CONCLUSIONS

The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.

Transition to professional practice: Perspectives of new nursing graduates of Nepal

BACKGROUND

Internationally, the transition from student nurse to practicing nurse is recognized as being the most stressful period. Yet very little is known about how new nursing graduates perceive this transition in Nepal. The study aimed to explore new nursing graduates' perceptions of the transition to professional practice.

METHODS

A qualitative descriptive methodology was used. In-depth semi-structured interviews were conducted with 10 purposively recruited participants from two private hospitals in Nepal. Data were analyzed using inductive thematic analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to report the findings of this study.

RESULTS

New nursing graduates perceived the transition to professional practice as an intense experience. Inductive thematic analysis yielded four intrinsically linked themes that encompassed new nursing graduates' transition experiences: 'getting hit by reality', 'losing confidence', 'feeling unsupported', and 'gathering strengths.' The theme 'getting hit by reality' included three sub-themes: 'gap between theory and practice,' 'no protective shield,' and 'plethora of responsibilities', which explains nurses' initial encounter with real-world practice. The theme 'losing confidence' contained three sub-themes: 'being fearful,' 'being ignored,' and 'being accused,' which describes how nurses started losing confidence as they confronted the real side of the profession. The theme 'feeling unsupported' included two sub-themes: 'left without guidance,' and 'limited support from seniors,' which explains how nurses perceived their work environment. The theme 'gathering strength' contained two sub-themes: 'reflecting' and 'asking for help,' which describes how nurses coped with the challenges related to the transition.

CONCLUSION

To facilitate the transition to practice, educational institutions must impart to students a realistic understanding of the transition process, address the theory-practice gap, and collaborate with hospitals. Similarly, hospitals should have realistic expectations from new nurses, assign work according to their capabilities, and allow them sufficient time for role integration. Likewise, well-conceived detailed orientation, mentorship or preceptorship programs, and regular professional development programs are vital to easing the transition. Furthermore, establishing and maintaining a supportive work culture, which promotes equity, respect, and safety among employees, is crucial for positive transition experiences.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs

Background

The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward.

Purpose

To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic.

Methods

We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data.

Results

The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19.

Conclusion

This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

Practice readiness of new graduate nurses and factors influencing practice readiness: A scoping review of reviews

BACKGROUND

For many years there has been concern that new graduate nurses may not have been adequately prepared for the workplace, often framed in terms of whether they are work ready or practice ready and able to deal with the 'reality shock' of transitioning from student to clinician. This has prompted significant research to investigate the practice readiness of new graduate nurses.

OBJECTIVES

Identify what is known about the practice readiness of new graduate nurses upon commencement of employment, how practice readiness changes over their first year of employment and explore the factors which influence practice readiness.

DESIGN

Scoping review of existing reviews guided by the framework developed by Arksey and O'Malley, with search results based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

METHODS

MEDLINE, CINAHL, PsycINFO, Scopus and Web of Science were searched to identify literature reviews synthesising evidence about new graduate nurses, work readiness, practice readiness, competency and transition to practice. New graduate nurses were defined as nurses who were working in any clinical setting as a nurse within their first year of employment after graduation. Database searching was supplemented with snowball searching and limited to English language papers published between 2011 and 2020. Full-text copies of included reviews were imported into an NVivo (Version 12) database to facilitate analysis and synthesis of findings.

RESULTS

Forty-five reviews were included. The findings indicate that transition is influenced by a wide range of intrapersonal, interpersonal and organisational factors, many of which are beyond the control of new graduate nurses. The findings also suggest that, overall, there are no major concerns about the practice readiness of new graduate nurses consistently supported by strong evidence. However, there is evidence to suggest that they 'lack confidence' during the first few months of employment.

CONCLUSIONS

The 'receptivity' of the clinical environment to new graduate nurses appears to be a critical influence on their experience of transitioning from student to clinician and can also influence their readiness for the role of a registered nurse. Rather than focusing on the question of whether new graduate nurses are adequately prepared for the workplace, it may be time to shift the question to whether the workplace is ready to support new graduate nurses. The findings suggest two research priorities for advancing our understanding of workplace support for new graduate nurses.

The practice of rural and remote nurses in Australia: A case study

AIM AND OBJECTIVE

To delineate contemporary practice of registered nurses working in rural and remote areas of Australia.

BACKGROUND

Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources.

DESIGN

A multiple case study design was implemented.

METHODS

Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used.

RESULTS

Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are "a medley of preparation for rural and remote work"; "being held accountable"; "alone, with or without someone"; and "spiralling well-being."

CONCLUSIONS

Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues.

RELEVANCE TO CLINICAL PRACTICE

Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

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.

Transition shock and newly graduated nurses' job outcomes and select patient outcomes: A cross-sectional study

AIM

This study examined transition shock experiences in newly graduated nurses as well as its relative influence on job outcomes (job satisfaction, stress and burnout, and intent to leave their organisation) and select patient outcomes (missed care, adverse events and perceived quality of care).

BACKGROUND

Transition shock is a reality common among newly graduated nurses and has been considered an issue relevant to nursing administrators. To date, the mechanism by which transition shock perception is linked with nurse and patient outcomes remains unexplored.

METHODS

A descriptive, cross-sectional design was used. One hundred seventy-six newly graduated nurses (nurses with <1 year of work experience) were included in the study. Data were collected using seven standardized scales.

RESULTS

Hospital classification (e.g., being employed in a government-owned hospital) (β = 0.255; p = .001) predicted transition shock. Overall, newly graduated nurses reported greatest challenges with regard to their expectations of the actual work environment (mean = 2.60, standard deviation = 0.42) and in balancing their professional and personal lives (mean = 2.51, standard deviation = 0.35). Higher levels of reality shock were associated with adverse patient events (β = 0.821; p = .001).

CONCLUSION

New graduates experience great challenges in balancing their professional and personal lives. Ensuring work-life balance and work readiness in newly graduated nurses may potentially reduce the occurrence of missed nursing care and adverse events.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can adequately support newly graduated nurses' transition through the implementation of empirically based transition programmes. By providing flexible work arrangement, reasonable workload, adequate nurse staffing, limited mandatory overtime and self-scheduling, nurse managers can effectively assist newly graduated nurses in attaining work-life balance.

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.

Transition experiences of newly graduated Filipino nurses in a resource-scarce rural health care setting: A qualitative study

PROBLEM

Without a doubt, the transition to a professional nursing role is a challenging and stressful experience for many new nurses, regardless of where they are employed; yet, no study has been conducted to comprehend in detail the transition experiences of newly graduated nurses employed in a resource-scarce rural health care setting.

PURPOSE

This study describes the transition experiences of newly graduated Filipino nurses during their initial clinical placement process.

METHODS

A qualitative phenomenological approach using structured interviews with 15 newly graduated Filipino nurses were used along with the Coliazzi's methodological framework for data analysis.

FINDINGS

Four distinct themes emerged from the content analysis, as follows: experiencing transition shock, feeling pressured, learning excitement, and needing support.

CONCLUSIONS

Similar to the findings of other international studies, newly graduated Filipino nurses described their transition experiences as a stressful and challenging journey. Both academic and nursing administration team members can play key roles in facilitating a smooth transition and the integration of new nurses into the nursing workforce through the employment of evidence-based educational and structured organizational strategies.