Effectiveness of transition programs on new graduate nurses' clinical competence, job satisfaction and perceptions of support: A mixed-methods study

The Omission of Nursing Care in Emergency Departments: A Conceptual Analysis Using Walker & Avant's Methodology

AIM(S)

To analyse the dimensions of the omission of nursing care in emergency departments, including its attributes, antecedents, and consequences, using Walker & Avant's concept analysis method.

DESIGN CONCEPT ANALYSIS

Methods: Walker and Avant's eight-step method defined attributes, antecedents, and consequences of the omission of nursing care in emergency departments.

DATA SOURCES

A comprehensive literature review was conducted using CINAHL, MEDLINE, Embase, Health Management Database, and Cochrane Library, covering publications from 2001 to 2024. The search was conducted in August 2024.

RESULTS

Key attributes were delayed, incomplete, or interrupted care, mostly due to insufficient staffing or unpredictable patient volumes. Antecedents included high workloads, inadequate skill mixes, and understaffing. Consequences were increased patient morbidity and mortality, nurse burnout, and job dissatisfaction. A research gap exists in paediatric-specific measurement tools.

CONCLUSION

Identifying dimensions of omitted nursing care in emergency departments informs interventions to improve patient safety and care quality. Developing paediatric-specific measurement tools is essential.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings emphasise the need for improved staffing and resource allocation policies, reducing risks to patients and enhancing nurse satisfaction.

IMPACT

This study addressed the gap in understanding omitted nursing care specifically in emergency departments. Findings highlight systemic issues impacting patient outcomes and nurse well-being. The results will guide organisational improvements and future research globally.

REPORTING METHOD

This study adhered to EQUATOR guidelines, following Walker and Avant's method for concept analysis.

PATIENT OR PUBLIC CONTRIBUTION

This study did not include patient or public involvement.

IMPACT STATEMENT

This study underscores the critical impact of the omission of nursing care (ONC) in emergency departments (EDs) on patient safety, nurse well-being, and healthcare efficiency. ONC contributes to increased morbidity, mortality, and adverse events, highlighting the urgent need for improved staffing models and resource allocation. Training programmes should equip emergency nurses with prioritisation strategies to mitigate care omissions. Policymakers must recognise ONC as a key quality indicator, ensuring adequate workforce support. Additionally, this study identifies a gap in measuring ONC in paediatric EDs, calling for the development of tailored assessment tools and further research on intervention strategies.

Navigating the transition: Graduate midwives' experiences with the implementation of a formal practice assessment tool

PROBLEM

New graduate midwives report dissatisfaction, stress and fear with a lack of structured clinical support and lack of personalised learning objectives. There is no practice assessment tool currently used to benchmark midwives practice in their graduate year.

BACKGROUND

In Australia there is no program for graduate midwives that includes use of a performance appraisal tool to provide benchmarks of clinical performance against the professional practice standards. Such an instrument has the potential to prompt a discussion between assessor and new graduate and facilitate a critical reflection on practice.

AIM

The aim of this study was to explore graduate midwives experience of the implementation of a practice assessment tool.

METHODS

This study used a descriptive qualitative design. Twelve graduate midwives were purposively sampled from one hospital in Australia and participated in focus group interviews. Data were analysed using an inductive approach.

FINDINGS

Three themes were generated: The influence of a sociopolitical environment on professional development; a paradox of stability amid uncertainty and a catalyst for practice improvement.

DISCUSSION

Pragmatic improvements for the assessment process including familiarity of the assessor, allowing time to adapt to new clinical areas and having transparent assessment schedules. Organisational factors need to be addressed to support optimal graduate development within the clinical environment.

CONCLUSION

The practice assessment tool when used in the correct context and by suitable assessors is an appropriate tool that can be used to provide objective feedback to graduate midwives and prompt reflective practice.

Professional Role Transition in Nursing: Leveraging Transition Theory to Mitigate the Current Human Resource Crises

New graduate nurse (NGN) turnover is emerging as one of the foremost issues in healthcare systems, primarily due to the implications for patient care and the need to secure the human resource future of the nursing profession. The initial months of transitioning into the professional role are crucial for cultivating and developing clinical practice patterns, professional values and a connection to the profession. However, the initial transition period for new nurses is associated with numerous challenges that can interrupt a healthy introduction into practice, justifying the critical prioritization of these issues. In light of these challenges to NGN entry to practice, this paper aims to conceptualize the contemporary professional role transition experiences of new graduate nurses and highlight the potential leverage that transition theories offer in managing this experience. Eleven transition theories relevant to this discourse were identified to enhance the understanding and comprehension of the new graduate nurses to inform future initiatives, directives, interventions and policies.

Effect of a Practice-Oriented Electronic Medical Record Education Program for New Nurses

Background/Objectives: New nurses often face challenges in adapting to clinical environments, particularly in mastering electronic medical record (EMR) systems, which are critical for effective patient care and communication. This study aimed to evaluate the effectiveness of a practice-oriented EMR education program designed to improve new nurses' EMR competencies. Methods: A quasi-experimental pretest-post-test design with a non-equivalent control group was employed. Fifty-four new nurses employed for less than a year participated, with 25 in the intervention group and 29 in the comparison group. The intervention group underwent five weekly sessions focused on core EMR tasks, including admission nursing, operation/procedure documentation, patient transfer/discharge, night duties, and SBAR handovers. The program, led by clinical nurse educators, incorporated lectures, practical exercises, and Q&A sessions. EMR competencies were assessed using a validated 5-point Likert scale. Results: The intervention group showed significant improvements across all assessed domains, with post-program scores significantly higher than those of the comparison group. The most notable improvements were in operation/procedure documentation and patient transfer/discharge tasks. The comparison group's gains were limited, likely reflecting natural skill acquisition through clinical experience. Conclusions: The practice-oriented EMR education program effectively enhanced new nurses' EMR competencies. The program's structured approach, which combined theoretical instruction with extensive hands-on practice and department-specific adaptations, proved particularly effective in improving complex documentation tasks. The integration of comprehensive EMR training into nursing curricula and the expansion of such programs to other institutions are recommended for broader implementation.

Promoting Safe Practice in New Graduate Nurses: The Key Role of Support

This article reports research that examined how registered nurses in practice develop clinical judgment in new graduate nurses (NGNs) and how NGNs respond. Teaching themes were setting the tone for learning, use of cognitive-focused teaching-learning strategies, including mentoring thinking, debriefing and reflection, and using real-life scenarios. NGN responses were learning focused, emotional, or resistant. Recommendations to support development of clinical thinking are made.

Observed Use of Clinical Judgment Among New Graduate Nurses

BACKGROUND

Despite the efforts of academic nursing educators to prepare students to make sound clinical judgments, the literature suggests new graduate nurse (NGN) competence with this critical skill continues to decline. This study sought to identify how practicing nurses describe their observations of the use and outcomes of clinical judgment by NGNs in nursing practice.

METHOD

A multisite, cross-sectional survey using multiple-choice, Likert scale, and open response items to identify participants' observations of NGN clinical judgment was sent with snowball sampling and resulted in a sample of 314 participants from 19 U.S. states.

RESULTS

Practice partners identified a wide discrepancy between how they expect NGNs to use clinical judgment and what they actually see NGNs do, with resultant negative effects on patients and NGNs.

CONCLUSION

These results provide a beginning understanding of NGNs' specific challenges with clinical judgment. Efforts to improve clinical judgment across nursing education and practice are needed. [J Contin Educ Nurs. 2024;55(8):399-406.].

Factors influencing the job embeddedness of new graduate nurses: A multicentre cross-sectional study

AIM

To identify factors associated with job embeddedness from the perspective of retaining new graduate nurses.

DESIGN

The study was cross-sectional in design.

METHODS

Convenience and stratified sampling were used to recruit 415 newly graduated nurses from 12 tertiary hospitals in China. Anonymized data were collected through self-designed sociodemographic questionnaires, job embeddedness scale, feedback-seeking behaviour scale, authentic leadership perception scale and decent work scale. Appropriate indicators were used for descriptive statistics and t-tests, ANOVA, Pearson correlation analysis and multiple linear regression to examine the influencing factors.

RESULTS

The study showed that monthly income level, decent labour, authentic leadership and feedback-seeking behaviour were significant predictors of job embeddedness among new graduate nurses.

CONCLUSION

The job embeddedness of new graduate nurses is moderate. Nursing managers need to construct reasonable and fair compensation incentives, adopt positive leadership styles and encourage proactive feedback-seeking behaviours to improve the job embeddedness of new graduate nurses and alleviate the nursing talent shortage.

IMPACT

Exploring the factors influencing the job embeddedness of new graduate nurses provides a reference for establishing new graduate nurse retention strategies to help promote the career development of new graduate nurses and alleviate the nursing brain drain.

REPORTING METHOD

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Relationship among core competency, self-efficacy and transition shock in Chinese newly graduated nurses: a cross-sectional study

OBJECTIVES

To investigate how core competency and self-efficacy of newly graduated nurses affect their experience of transition shock, and to determine the relationship between these factors.

DESIGN

A cross-sectional study.

METHODS

262 newly graduated nurses participated in a cross-sectional study by using demographic data, the transition shock scale, the competency inventory for registered nurses scale and the self-efficacy scale.

RESULTS

Among newly graduated nurses, the score of transition shock was 77.641±24.140, the score of core competency was 125 (109.5, 163.5) and the score of self-efficacy was 2.5 (2,3), all of which were at a moderate level. The core competency and self-efficacy of the newly graduated nurses had a negative impact on the transition shock (β=-0.151, p=0.026; β=-0.379, p<0.001). Additionally, self-efficacy played a mediating role in the relationship between core competency and transition shock, with a mediating effect accounting for 57.34% of the total effect.

CONCLUSIONS

The transition shock of newly graduated nurses was at a moderate level, with the highest level of transition shock occurring within the first year of employment. Self-efficacy plays a mediating role in the relationship between core competency and transition shock. Nursing managers should create standardised training for newly graduated nurses within the first year of employment to reduce their transition shock. This will help improve newly graduated nurses' core competency, enhance self-efficacy and support the graduates. This will alleviate the impact of transition shock on newly graduated nurses, helping them transition smoothly and successfully.

Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography

BACKGROUND

The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace.

AIM

To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment.

DESIGN

A focused ethnographic study.

METHODS

Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022.

RESULTS

The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.'

CONCLUSION

Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover.

RELEVANCE FOR CLINICAL PRACTICE

A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures.

REPORTING METHOD

This study reports to the SRQR guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

When and how does the practice environment most benefit the job outcomes of newly graduated nurses?

BACKGROUND

Providing a favourable practice environment has been regarded as an essential to improve the job outcomes of newly graduated nurses (NGNs). However, little is known about how and when NGNs can best utilize their practice environment to produce optimal job outcomes.

AIM

The aim of this study, which is based on the Conservation of Resources Theory and the Social Cognitive Model of Career Self-Management, is to investigate whether NGNs who have a higher level of personal growth initiative are more likely to benefit from their practice environment and achieve better job outcomes by increasing their occupational self-efficacy.

DESIGN

A cross-sectional study.

METHODS

From 1 September 2022, to 30 September 2022, 279 NGNs from five Chinese state-owned hospitals were recruited for this study. The participants completed measures of practice environment, personal growth initiative, occupational self-efficacy, job stress, job satisfaction, turnover intention and quality of care. A descriptive analysis and a moderated mediation model were computed. Reporting adhered to the STROBE statement.

RESULTS

The influence of the practice environment on job outcomes was significantly mediated by occupational self-efficacy, with personal growth initiative acting as a moderator of this mediation effect.

CONCLUSIONS

NGNs who exhibited a higher degree of personal growth initiative were more likely to derive benefits from their practice environment and attain positive job outcomes by enhancing their occupational self-efficacy. To boost NGNs' occupational self-efficacy and achieve optimal job outcomes, hospital administrators may not only provide a supportive practice environment for them but also conduct interventions that promote their personal growth initiative.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was designed to examine the psychosocial factors associated with NGNs' job outcomes. The study was not conducted using suggestions from the patient groups or the public.

IMPACTS

Our findings indicate that favourable practise contexts may not always benefit the nursing job outcome if NGNs do not exhibit a high level of personal growth initiative and produce increased occupational self-efficacy. Therefore, hospital administrators should consider implementing an intervention to improve the personal growth initiative of NGNs so that they can take full advantage of the practice environment and gain resources at work to create optimal job outcomes.