New graduate registered nurses' experiences with psychological safety

Navigating a nursing career four years after graduation: A qualitative descriptive study exploring drivers of staying amid wanting to leave

AIM

To explore the lived experience of Early Career Nurses four years post-graduation and identify factors influencing their decision to stay in or leave the profession.

BACKGROUND

The retention of Early Career Nurses is a critical issue globally, with many leaving the profession within the first few years. Various interventions have been implemented to support Early Career Nurses, but the complexities of retention require a more nuanced understanding, particularly for those in the latter stages of their transition.

DESIGN

A qualitative descriptive study.

METHODS

Early Career Nurses who participated in a longitudinal study as undergraduate nursing students were interviewed 48 months after graduation. The study used phenomenological approach to explore key experiences and phenomena. Data were analysed using Thematic Analysis, adhering to COREQ guidelines.

RESULTS

Among the 25 participants, key themes identified included being 'Overworked and undervalued' and being 'Anchored by care.' Early Career Nurses experienced significant pressures, including incivility, poor management and staffing shortages, leading to a desire to leave the profession. However, a strong commitment to patient care and support from peers and family helped some Early Career Nurses remain in the profession.

CONCLUSION

The study highlights the need for systemic changes to support Early Career Nurses, including empathetic leadership, adequate training and supportive work environments. Addressing these issues is essential for the wellbeing of Early Career Nurses and maintaining high standards of patient care. Understanding the unique challenges faced by Early Career Nurses can inform strategies to improve retention and support their professional development.

Educational Disparities in Professional Identity and Career Path Planning for Newly Graduated Nurses in China

BACKGROUND

Professional identity is a pivotal factor that influences career path planning for nurses. Few studies have examined the relationship between these two variables among newly graduated nurses (NGNs). This study assessed the association between professional identity and career path planning and examined educational disparities among NGNs in China.

METHOD

A cross-sectional study was conducted to assess 238 NGNs. The Professional Identity Scale for Nursing Students and a career path planning questionnaire were used.

RESULTS

Compared with NGNs with associate's degrees, those with bachelor's degrees had lower professional identity, were less likely to choose clinical nursing, and more often selected nursing research or specialized nursing as their career paths. Multinomial logistic regression analysis showed that career path planning was significantly associated with professional identity and educational level.

CONCLUSION

Educational disparities were found between professional identity and career path planning, highlighting the need for tailored orientation training for NGNs with different educational levels in China. [J Contin Educ Nurs. 2025;56(4):158-164.].

Psychological safety mediates attendance and recovery-related outcomes within the Phoenix: a sober-active community

Background

People in recovery from a substance use disorder often have difficulties forming pro-social relationships or accessing supportive communities. Providing psychological safety within recovery communities may be uniquely beneficial, yet psychological safety has mostly been studied among professional organizations and not among vulnerable populations. This program evaluation study examined associations between attendance, psychological safety, and retrospective recovery-related changes.

Methods

Participants included 204 members of The Phoenix (13% response rate) who completed a survey that addressed recovery status and current perceptions of psychological safety, with hope, connection, empowerment, motivation to stay sober, mental health and physical health at 3-months and thinking back to baseline (i.e., "thentest"). Demographic information and attendance data were also collected.

Results

Structural equation modeling found a good fit for the model (χ2 = 187.40, p = 0.23; RMSEA =0.049, GFI = 0.90, CFI = 0.98, SRMSR = 0.05.) and all path coefficients were statistically significant (p < 0.05). Participants' perceived psychological safety fully mediated the relationship between attendance and recovery-related outcomes. Attendance was also directly and positively associated with physical health.

Conclusion

Due to positive improvements in health and recovery-related outcomes mediated by psychological safety, results show benefits of attending events hosted by The Phoenix for those in recovery from substance use. Additional research should further validate the importance of psychological safety as a key mediator of the recovery process.

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.

The importance, challenges, and proposed solutions for preceptors to educate the nursing workforce

Preceptors are essential in the clinical education of prelicensure registered nursing and advanced practice registered nursing students. However, there is a growing scarcity of preceptors available to provide clinical education. Additionally, preceptors have not uniformly received professional development in the practice of teaching that is essential in delivering high quality clinical education, and clinical education in nursing is an unfunded mandate. This article reviews the current state of preceptors, the importance and challenges of preceptors in clinical education, the lack of funding for clinical education by preceptors, and proposed solutions.

Assessing employee silence about patient safety and its association with environmental factors among nurses in Ardabil: a cross-sectional study

BACKGROUND

Nurses have a crucial role in recognizing potential dangers to patient safety during direct patient care. However, there are occasions when they opt to stay quiet instead of voicing their concerns, ultimately endangering patients. The underlying reasons for this silence pose a significant challenge in the nursing industry. While it's known that workplace conditions contribute to this silence, the specific ways in which this occurs need to be clarified. This research aimed to investigate the factors that lead nurses to remain silent about patient safety, specifically focusing on environmental influences in Ardabil City.

METHODS

This descriptive and analytical study examined 630 nurses, including head nurses, from five medical training centers in Ardabil, northwest Iran. The primary instruments used in the research included the Employee Silence about Patient Safety Questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of psychological safety, leader-member exchange (LMX) assessments, and evaluations of professional discrimination. Data analysis was performed using SPSS version 16.0, applying descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficient, and hierarchical regression analysis.

RESULTS

The average score for employee silence regarding patient safety was 2.62, with a standard deviation of 0.98. Several factors were found to be significant predictors of employees' silence about patient safety, including nurse participation in hospital affairs (ß = 0.196, p = 0.002), nurse's role in the quality of care (ß = -0.352, p < 0.001), staff and facility adequacy (ß = 0.156, p = 0.001), communication with the physician (ß = -0.105, p = 0.015), LMX (ß = -0.284, p < 0.001), and job position (ß = -0.093, p = 0.018).

CONCLUSION

This study has identified several critical factors influencing employee silence regarding patient safety, including nurse involvement in hospital decision-making, the quality of care, communication with physicians, and job positions. To address these challenges, healthcare organizations must implement standardized protocols, improved communication channels, regular safety training, and the integration of advanced technologies. Increasing nurse participation in decision-making processes and strengthening communication between nursing staff and physicians can foster a culture of openness that encourages employees to voice their safety concerns. By creating an environment where staff feel supported and empowered to speak up, healthcare facilities can enhance patient safety and improve overall care quality, ultimately leading to a safer working environment for healthcare professionals.

Transition shock experience of newly graduated nurses: a qualitative study

AIM

This study aims to gain an in-depth understanding of the experience and requirements of newly employed nurses during their transition into professional roles. Furthermore, it aims to analyze the effects of transition shock on these nurses, identify the typical coping mechanisms they employ, and provide a reference for nursing administrators to explore and improve relevant interventions.

BACKGROUND

In the early stages of their careers, newly graduated nurses frequently encounter various challenging situations that might impact their job performance and professional growth. Over the past few years, experts have increasingly focused on transition shock. However, limited studies have been undertaken on the role adaptation factors related to freshly graduating nurses during their transition.

METHODS

The study's design and implementation were guided by the phenomenological method. Purposive sampling and semi-structured in-depth interviews were used to recruit 16 participants. Interviews were transcribed verbatim, and the data were analyzed using thematic techniques assisted by Nvivo coding software.

RESULTS

We analyzed interview data based on Duchscher's transition shock theoretical framework. A total of 3 themes and 12 sub-themes were distilled, which include perceptions and feelings when facing transition shocks (4 sub-themes), impacts of transition shocks (4 sub-themes), and strategies for coping with transition shocks (3 sub-themes).

DISCUSSION AND CONCLUSION

Newly recruited nurses are prone to suffer multidimensional problems and impacts during the transition process, mostly characterized by physical discomfort, psychological anxiety, and the need for social support and career development. Nursing managers should pay attention to the mental health status and changes of new nurses at different stages and proactively investigate and implement personalized interventions.

Pre-licensure nursing students' experiences of psychological safety: A longitudinal qualitative study

BACKGROUND

Previous studies have explored the concept of psychological safety among pre-licensure nursing students; however, the literature is notably sparse on personal descriptions of pre-licensure nursing students' experiences of psychological safety in clinical settings. Individual descriptions of psychological safety will provide added insight and understanding about the elements that shape psychological safety in pre-licensure nursing students.

AIM

This research aimed to explore pre-licensure nursing students' experiences of psychological safety during clinical rotations and how these experiences change over time.

DESIGN

A longitudinal, qualitative, descriptive design was used for this study.

SETTINGS

Participants were recruited from a nursing program in the Mountain West region.

PARTICIPANTS

Fifty-four students from three cohorts were enrolled in the study at the time of this data collection and analysis.

METHODS

Each participant completed a semi-structured telephone interview after finishing their first academic term involving a clinical rotation. Participants completed additional interviews after each subsequent semester. Individual waves of data were analyzed using thematic analysis, and multiple waves of data were analyzed using a simplified trajectory approach.

RESULTS

Five themes emerged from the data: "Who I Am," "Where I Am," "Who I Am With," "Responding in the Moment," and "Anticipating the Future."

CONCLUSIONS

The psychological safety of pre-licensure nursing students in clinical settings is fundamental to their learning and future practice within the nursing profession. The development of psychological safety is dynamic and multifaceted. It is interpersonal but also shaped by organizational factors. Any one person can make an outsized difference in a student's experience. Understanding these themes can help clinical preceptors and nursing faculty understand and better fulfill their respective roles in fostering psychological safety in clinical settings. Additional insights are expected as the longitudinal study continues.

Transition to Practice: Perceptions of Newly Graduated Nurses in Relation to the Participation of Nurse Managers in a Transition Program

Throughout existing transition programs for new nurses, few appear to include the participation of nurse managers in its activities. This qualitative study explores the perceptions of newly graduated nurses ( N = 7) toward the participation of their nurse manager in a transition program through dedicated group discussion periods. Four interconnected themes emerged from the interviews. Our findings support the inclusion of this participation in transition programs by nurse leaders to improve the transition experience of new nurses.

Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study

BACKGROUND

In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce.

OBJECTIVE

This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning.

METHODS

A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined.

RESULTS

In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned.

CONCLUSIONS

This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context.

Discovering nurse mode: A phenomenological study of nursing student role micro-transitions

AIM

To explore the experiences of undergraduate nursing students in navigating daily micro-transitions between nursing and non-nursing roles.

BACKGROUND

Nursing students develop professional role identity through socialization, experience, and practice while simultaneously managing pre-existing personal roles. This dynamic creates a training ground for future sustainable practice.

DESIGN

Qualitative, cross-sectional, interpretive phenomenological design with hermeneutics.

METHODS

Seventeen undergraduate nursing students participated online in semi-structured, audiovisual-recorded interviews until data saturation was reached.

RESULTS

Three main themes emerged: 1) Strategies for Getting In and Out of Nurse Mode, 2) Cultivating Mindful Nursing Practice, and 3) Nursing Student Socialization and Immersion. Findings indicated that nursing students noticed benefits in their personal and professional lives as they developed this skill. Findings also suggested that students need support from their educators to ensure they are not trapped in nurse mode while learning to navigate nurse role identity.

CONCLUSIONS

Understanding and supporting nursing students in managing role micro-transitions are crucial. Findings indicated a functional need for nursing students to understand and apply knowledge and skills regarding a) when to initiate a role micro-transition and b) how to complete a micro-transition effectively between a nursing and non-nursing role. Educational strategies and support systems addressing this need may improve future nursing professionals' quality of life and clinical practice.

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.

The ecology of human flourishing embodying the changes we want to see in the world

Flourishing is the highest good of all persons, but hard to achieve in complex societal systems. This challenge is borne out through the lens of the global nursing shortages with its focus on the supply of nurses to meet health system demands. However, nurses and midwives spend a significant part of their lives at work and so the need to pay attention to the conditions that facilitate flourishing at work is important. Drawing on ancient and contemporary philosophies, as well as critical, creative and embodied ways of knowing, enabling a flourishing practice ecosystem will be explored in this paper.

Just Culture: Nursing Students Transition to Practice-a Longitudinal Study

BACKGROUND

Although just culture is reportedly integrated across education and practice, little is known about how perceptions may change across time as students transition from prelicensure education to registered nurse in the practice setting.

PURPOSE

The purpose of this study was to describe and compare just culture perceptions of registered nurses at 2 time points: (1) as prelicensure students and (2) as new graduate nurses with a minimum of 6 months of experience.

METHODS

Utilizing the Just Culture Assessment Tool for Nursing Education (JCAT-NE) and the Just Culture Assessment Tool (JCAT), this within-subject, longitudinal study measured just culture perceptions across time.

RESULTS

Although there was no statistically significant change in total scores across time, 8 individual items demonstrated statistically significant change.

CONCLUSIONS

Students use the knowledge, skills, and attitudes about just culture taught in prelicensure education as new graduate nurses. However, findings reveal areas where the practice environment has altered perceptions of just culture.

Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study

For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.

Nurse manager support of graduate nurse development of work readiness: An integrative review

AIM

To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness.

BACKGROUND

Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment.

DESIGN

A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist.

METHODS

The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework.

DATA SOURCES

MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020.

RESULTS

Studies eligible for inclusion (N = 40) represented research from 15 countries; most (67.5%, n = 27) used a qualitative design, 22.5% (n = 9) were quantitative and 10% (n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning.

CONCLUSION

The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness.

IMPLICATIONS FOR THE PROFESSION OR PATIENT CARE

Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce.

IMPACT

What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

Umbrella review: Newly graduated nurses' experiences of providing direct care in hospital settings

AIM

To summarize existing research syntheses reporting newly graduated registered nurses' experiences of providing direct care in hospital settings.

DESIGN

Umbrella review.

DATA SOURCES

An extensive search of all relevant databases was conducted for research syntheses. Initial key terms included "new* nurse", "nursing care" and "hospital setting" in combination with index terms to find relevant literature.

METHODS

Critical appraisal, data extraction and summary were performed independently by two reviewers according to the Joanna Briggs Institute guidelines for undertaking umbrella reviews.

RESULTS

Nine research syntheses published between 2010 and 2019 and representing 173 studies were included following critical appraisal. The evidence was summarized in narrative form with supporting tables. Twenty-six sub-branches and seven main-branches were organized in a coding tree showing the structure of three overlapping themes: "Feeling a lack of competency", "Sense of emotional distress" and "In need of support".

CONCLUSIONS

Evidence demonstrates that newly graduated registered nurses' experiences of a lack of competency, emotional distress and need for support emerged as essential requirements for the provision of competent and safe direct care for the patient.

IMPACT

Newly graduated registered nurses face multiple challenges in the transition from student nurse to practicing nurse. Unmet expectations of being a newly graduated nurse might lead to low levels of job satisfaction, high attrition rates or missed nursing care. Nurse educators, leaders and policy makers should be mindful that newly graduated registered nurses' perceptions of professional and personal identity and degree of support influences newly graduated registered nurses' direct care provision.

Investigating the complex relationships between leadership, psychological safety, intrinsic motivation, and nurses' voice behavior in public hospitals using PLS-SEM

Background

Voice behavior among nurses in public hospitals lacks profound disclosure despite knowing its imperatives. This situation needs to be continuously studied, and the best practices discovered, disclosed, and implemented in hospitals that are serious in curbing unprofessional conduct while advancing healthcare requirements for the benefit of humanity.

Objective

This empirical research investigated the significant implications of psychological safety and intrinsic motivation in the mostly uncultivated link concerning the empowering leadership style and leader-member exchange (LMX) constructs and the practice of voice behavior among nurses in the selected Malaysian public hospitals.

Methods

Primary data of the study were from nurses employed in the selected large public hospitals within the Klang Valley, also known as the Greater Kuala Lumpur of Malaysia. A total of 366 complete and valid responses were collected with the help of head nurses via a self-administered survey in February 2020. The SmartPLS 4 for Windows software generated the standard partial least squares structural equation modeling (PLS-SEM) to estimate associations between research variables and evaluate the model's strength in explaining the proposed constructs.

Results

This research disproved the indirect effects of psychological safety on the connection explorations between empowering leadership-voice behavior (β = 0.015, t-value = 0.300, 95% CI [-0.090, 0.110]) and LMX-voice behavior (β = 0.002, t-value = 0.285, 95% CI [-0.014,0.020]). Intrinsic motivation partially mediates the link between empowering leadership-voice behavior (β = 0.214, t-value = 7.116, 95% CI [0.160, 0.279]) and LMX-voice behavior (β = 0.114, t-value = 4.669, 95% CI [0.071, 0.168]) of the nurses.

Conclusion

Patients, non-governmental organizations, volunteers, nurses, and other hospital staff are vested in how voice behavior signifies in the healthcare context. Essential factors for nurses to become more outspoken are discovered in this study, providing nurse managers and other leaders with numerous recommendations for encouraging vocal behavior and bolstering psychological safety and intrinsic motivation. More competent nurses will improve workplace culture, deliver superior healthcare services, and manage publicly financed hospitals with an overall sense of trust, but only after a substantial effort to execute reforms.

The relationships between clinical teaching behaviour and transition shock in newly graduated nurses

AIM

To explore the relationships between clinical teaching behaviour and transition shock in newly graduated nurses and significant differences in the northwest and northeast China.

DESIGN

A cross-sectional design.

METHODS

A total of 211 (nurses) and 925 (preceptors) were recruited in six Third-class different hospitals from July to August 2019.

RESULTS

The transition shock is negatively correlated with the clinical teaching behaviour in northwest and northeast China, while the transition shock in the northwest is higher than that in the northeast for the behindhand economy and natural limit.

CONCLUSION

The transition process of newly graduated nurses in northeast China with ethnic minorities and the behindhand economy is more difficult. For newly graduated nurses, personal health and a supportive environment need further improvement. Teaching strategies for preceptors need to be enhanced. Two-way feedback is more useful for both the newly graduated nurses and preceptors to improve quality care, and holistic care.

Prehospital nursing students' experiences of patient safety culture in emergency medical services-A qualitative study

AIMS AND OBJECTIVES

To describe prehospital nursing students' experiences of patient safety culture in emergency medical services during their internship.

BACKGROUND

Patient safety culture in the emergency medical services is a complex phenomenon including more than organisational policies and practices and professionals' technical skills.

DESIGN

The descriptive qualitative approach used the Sharing Learning from Practice to improve Patient Safety Learning Event Recording Tool, which includes both open-ended and structured questions.

METHODS

Purposeful sampling was used, and data were collected from graduating prehospital nursing students (n = 17) from three Finnish Universities of Applied Sciences. Open-ended questions were reviewed using thematic analysis, and frequencies and percentages were derived from structured questions. COREQ guidelines were used to guide this study.

RESULTS

Four themes were identified during the thematic analysis: environmental and other unexpected factors in emergency medical services, working practices and professionalism in emergency medical services, teamwork in emergency medical services and feelings related to patient safety events in emergency medical services. Patient safety events described by students were seldom reported in the healthcare system or patient files. According to the students, such events were most likely related to communication, checking/verification and/or teamwork.

CONCLUSIONS

This study shows that prehospital nursing students can produce important information about patient safety events and the reasons that contributed to those events. Therefore, emergency medical services organisations and managers should use students' observations to develop a patient safety culture in emergency medical services.

RELEVANCE TO CLINICAL PRACTICE

Understanding how prehospital nursing students have experienced patient safety culture during their internships on ambulances can support educational institutions, together with emergency medical services organisations and managers, to improve policies for students to express patient safety concerns as well as patient safety successes.

Role transition of newly graduated nurses from nursing students to registered nurses: A qualitative systematic review

BACKGROUND

The transition experience of newly graduated registered nurses is highly stressful and associated with high attrition rates.

OBJECTIVES AND DESIGN

This qualitative systematic review aims to consolidate the available evidence on the experiences of newly graduated registered nurses' role transition from nursing students to registered nurses.

DATA SOURCES

English language research published between 2010 and 2022 was searched using PubMed, CINAHL, Scopus, Embase, PsycInfo and ProQuest Dissertations and Thesis databases.

REVIEW METHODS

Data were extracted using a data extraction form and appraised using the Critical Appraisal Skills Programme (CASP) tool for published studies or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for unpublished studies or grey literature, respectively.

RESULTS

The review included 25 studies and the meta-synthesis identified four themes: (a) Knowledge deficit, (b) Overwhelming clinical practise, (c) Importance of workplace support, and (d) Meaning of "being a nurse".

CONCLUSIONS

Newly graduated registered nurses experienced facing knowledge deficits in the clinical setting and felt overwhelmed with work, especially for newly graduated registered nurses during the Covid-19 pandemic. Support from colleagues was invaluable, and they wished for better support through standardised transition programs. Despite nursing being mentally and physically exhausting, many newly graduated registered nurses regarded their profession satisfying and meaningful, however some eventually resigned. Understanding the transition experiences of newly graduated registered nurses can provide valuable insights on how to facilitate their transition and in turn decrease attrition rates, and ensure safe care for the patients and that public healthcare needs are met.

Key tips to providing a psychologically safe learning environment in the clinical setting

Having psychological safety embedded in preceptorship relationships facilitates positive interpersonal and educational experiences for students. Psychological safety refers to a student's belief as to whether or not it is safe for them to take interpersonal risks, such as asking questions, sharing an idea for improvement or speaking up to maintain patient safety. Having psychological safety leads to collaboration, positive student learning experiences and effective patient care. This article presents key guidelines for preceptors to provide a psychologically safe learning environment for their students. Guidelines fall under four categories 1) before meeting students, 2) first meeting students, 3) continued relationship with students, and 4) general rules. These guidelines are informed by current literature on psychological safety and preceptorship and the author's clinical expertise in nursing preceptorship. We conceptualise psychological safety in a nursing preceptorship for preceptors to denote the experience of inclusivity, empowerment, and well-being of students within the social, cultural and physical clinical learning environment. A crucial attribute to cultivating a psychologically safe environment involves being an accessible and approachable preceptor.

Cohort Study on the Effect of Psychological Education for Nurses in Psychiatric Department

With the deepening of the medical and health system, high-quality nursing service with the reform of nursing service model and the provision of holistic nursing care for patients as the core connotation is being comprehensively carried out. With the continuous improvement of medical quality, people's awareness of health has gradually increased. They have put forward higher requirements for medical quality, nursing service quality, and medical care safety. Under the influence of these conditions, the workload and work pressure of clinical nurses continue to increase, and mental health problems become increasingly prominent. According to relevant data, the detection rate of occupational stress among nurses was 100%, and the proportion of nurses who perceived considerable stress was 60.9%, which seriously affected their work efficiency and quality of life. However, the physical and mental health of the frontline nurses working in psychiatric hospitals is not optimistic. This study explored the effects of psychological education among nurses in the department of psychiatry. The results showed that psychological education intervention among nurses in the department of psychiatry could alleviate their professional tiredness, effectively improve their psychological elasticity and happiness index, and thus improve sleep quality and promote their physical and mental health development.

How nurse preceptors provide help to new nurses influences perceived relationship quality

BACKGROUND

In many hospitals, newly-hired registered nurses (RNs) enter into preceptorships, where they are paired with more experienced nurse preceptors who are responsible for ensuring effective transition to practice. Although high-quality relationships between preceptors and newly-hired nurses facilitate nurses' learning and integration into their medical institutions, preceptors have little guidance for what tactics develop such relationships.

OBJECTIVES

To investigate whether the type of help provided by preceptors (i.e., autonomous or dependent help) influences preceptees' evaluations of relationship quality and psychological safety with their preceptor. Furthermore, we investigate the role of instrumental support and emotional support as explanatory mechanisms.

DESIGN/SETTINGS/PARTICIPANTS/METHODS

Convenience sampling was used to collect data via a cross-sectional survey of 217 in-patient RNs hired between June 2016 and May 2018 to a magnet hospital within the Southwestern United States. Recently hired nurses evaluated their preceptor's help-giving tendencies, and reported on their perceived support, relationship quality and feelings of psychological safety with their preceptor.

RESULTS

Dependent help was positively related to instrumental support. Conversely, autonomous help was positively related to both relationship quality and psychological safety, and these relationships were partially mediated by perceived instrumental support and emotional support.

CONCLUSION

Findings illustrate the multiple benefits of autonomous help for encouraging high-quality relationships between preceptors and preceptees. This study identifies autonomous help-giving as a useful tactic for nurse preceptors (or other organizational insiders, such as mentors or supervisors) to establish high-quality relationships with recently hired nurses.

Factors influencing newly graduated registered nurses' voice behavior: An interview study

AIM

To gain insight into the factors that affect newly graduated registered nurses' voice behavior.

BACKGROUND

Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behavior.

METHODS

A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings.

RESULTS

In total, seven factors emerged from our data, which were grouped in four, overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence; (2) whether they feel encouraged and welcome to speak up; (3) their relationship with the voice target; and (4) the content of their voice message.

CONCLUSION

Factors that affect newly graduated nurses' voice behavior are multifaceted, but mostly center around time spent in and relationships at the workplace.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behavior. Specifically, induction programs, assigning mentors and offering additional training can support newly graduated nurses in developing voice behavior.

Factors Affecting Employee’s Retention: Integration of Situational Leadership With Social Exchange Theory

Sketching on the Social Exchange Theory (SET), the present study aims to investigate the direct relationship between training and development, work environment, and job satisfaction with employee retention. The contingent role of transformational leadership was also analysed under the Situational Leadership Theory (SLT). Accordingly, we collected data from 287 employees of SMEs in northern China by employing a convenience sampling approach, exhibiting a response rate of 57.40 percent. The Partial Least Square-Structural Equation Modelling (PLS-SEM) analysis was then run to test the proposed hypotheses. The findings revealed a significant positive impact of training and development, work environment, and job satisfaction on employee retention. However, no moderating effect of transformational leadership was indicated on their direct relationship. This study has enriched the literature on employee retention and the leadership arena. To the best of the authors’ knowledge, there is no prior evidence concerning the study’s integrated relationship of the continuous variables. The implications and limitations were finally expressed at the end of this manuscript.

An Innovative Workforce Initiative to Support New Graduate Nurses: Clinical Nurse Transition Coaches

Nursing leaders at Yale New Haven Health System identified a need among new-graduate nurses for further support beyond their accredited new-graduate residency program. The Clinical Nurse Transition Coach (CNTC) program focused on moving from individual tasks to caring for the entire patient, fostered by focused mentoring and education. The CNTC nurses were experienced and worked with a team of 10 new-graduate nurses.

Psychological Safety and Affective Commitment Among Chinese Hospital Staff: The Mediating Roles of Job Satisfaction and Job Burnout

Purpose

The affective commitment of hospital staff is important for human resources management and the sustainable development of hospitals. Psychological safety is an important factor that contributes to an emotional connection to an organization among staff, yet its functional mechanism remains unclear. This study explored how psychological safety influenced affective commitment through the mediating roles of job satisfaction and job burnout.

Methods

A battery of surveys were administered to all medical staff (n = 267) in a local second-grade comprehensive hospital. The surveys included the Psychological Safety Scale, Affective Commitment Scale, Minnesota Satisfaction Questionnaire, Maslach Burnout Inventory–Human Service Survey, and Perceived Organizational Support Scale.

Results

Job satisfaction and job burnout fully mediated the relationship between psychological safety and affective commitment among hospital staff. In addition, perceived organizational support moderated the mediating path via job burnout, and the indirect effect of job burnout decreased when perceived organizational support increased.

Conclusion

Psychological safety may enhance the affective commitment of hospital staff through improving job satisfaction or reducing job burnout. Perceived organizational support may counteract the deleterious effect of job burnout on affective commitment. Effective strategies to improve affective commitment among hospital staff may require consideration of job burnout and job satisfaction.

New graduate registered nurses: Risk mitigation strategies to ensure safety and successful transition to practice

The COVID-19 pandemic has impacted traditional pathways for new graduate registered nurses (NGRN's) transition to practice. In response to stay at home emergency orders in 2020, NGRN's experienced changes in pre-licensure curriculum, clinical practicums, NCLEX testing, and licensure, all which influence preparedness for professional practice. The adverse impact on education and clinical training extends to all nursing students who attended higher education institutions of learning during 2020 to present and is a significant consideration with new graduates over the long-term, whom will be caring for patients in healthcare settings. Well before this pandemic, literature identified that NGRN's were predisposed to knowledge-practice gaps and lacked situational awareness. Recent nursing research emerging from the pandemic reveals a potentiating negative impact of the abbreviated pre-licensure experiences on patient safety in the clinical setting. In the current healthcare environment, it is preemptive for healthcare institutions and schools of nursing to work cohesively to ensure patient safety through an increased emphasis on evidence-based approaches to reduce patient harm and mitigate harm when it does occur. Further, in response to the increased demand for nurses by healthcare organizations, considerations for safety, risk management, and ethical care must be considered during the transition to practice for NGRN's.

Career Adaptability of Newly Graduated Nurses at an Obstetrics and Gynecology Hospital in China: A Qualitative Study

AIM

To gain insight into factors affecting career adaptability of newly graduated nurses and ways to improve them.

BACKGROUND

Newly graduated nurses face an important transition from student to professional. Unfortunately, the nurse turnover rate is high due to maladaptation. Factors influencing career adaptability and improvement methods have not been clearly addressed.

METHODS

Using a descriptive qualitative study with thematic analysis, 15 newly graduated nurses from a tertiary obstetrics and gynecology teaching hospital in China were interviewed.

RESULTS

Six themes affecting career adaptability were found: personality, self-confidence, occupational care focus, work-related stress, basic professional competency, gap between reality and expectations. Four themes improving career adaptability were identified : strong social support, self-adjustment, self-development, career preparation. Eight sub-themes were also identified.

CONCLUSIONS

Individual, family, and work factors were among those affecting career adaptability among newly graduated nurses. Newly graduated nurses would improve their career adaptability through self-adjustment and social support. Helping them to promote these factors and measures is conducive to improving their career adaptability and reducing staff turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should be aware of the key factors affecting career adaptability among newly graduated nurses, and design targeted improvement programs.

Associations between safety outcomes and communication practices among pediatric nurses in the United States

PURPOSE

To gain a deeper understanding of RNs communication related to patient safety.

RESEARCH AIMS

To determine: (1) the associations between the communication of registered nurses (RNs) within their health care teams and the frequency that they reported safety events; (2) the associations between RNs' communication within their health care teams and their perceptions of safety within the hospital unit; and (3) whether RNs' communication had improved from 2016 to 2018.

THEORETICAL FRAMEWORK AND METHODS

We used the United Kingdom's Safety Culture model as the theoretical framework for this study. Our secondary data analysis from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture included 2016 (n = 5298) and 2018 (n = 3476) using multiple regression models to determine associations between responses for Communication Openness and Feedback & Communication About Error, and outcome responses for Frequency of Events Reported and Overall Perceptions of Safety.

RESULTS

Our findings were: 1). In both 2016 and 2018 datasets, Feedback About Error had a greater impact on Reporting Frequency than Open Communication; 2). Feedback About Error had a greater impact on Safety Perceptions than Open Communication; 3). Open Communication and Feedback About Error and their associations with Reporting Frequency and Safety Perceptions showed little change; and, 4). The proportion of variance was low, indicating factors other than Open Communication and Feedback About Error were involved with Reporting Frequency and Safety Perceptions.

CONCLUSION

Pediatric RNs' communication, reporting, and perceptions of patient safety have not improved. (245 words).

Social and Professional Impact of Learning Communities Within the Alliances for Graduate Education and the Professoriate Program at Michigan State University

At Michigan State University (MSU), the AGEP learning community features the participation of over 70% of the African-American, Latinx, and Native-American under-represented minorities (URM), also referred to as Black, Indigenous, and People of Color (BIPOC) doctoral students in fields sponsored by the National Science Foundation (NSF). Monthly learning community (LC) meetings allow AGEP participants to create dialogues across disciplines through informal oral presentations about current research. The learning communities also offer opportunities to share key information regarding graduate school success and experience; thus providing a social network that extends beyond the academic setting. At MSU, AGEP also provides an interdisciplinary and multigenerational environment that includes graduate students, faculty members, post-docs and prospective graduate students. Using monthly surveys over a 4-year period, we evaluated the impact of this AGEP initiative focusing on the utility of the program, perceptions of departmental climate, career plans and institutional support. Findings indicate that AGEP participants consider their experiences in the program as vital elements in the development of their professional identity, psychological safety, and career readiness. Experiences that were identified included networking across departments, focus on career placement, involvement in minority recruitment and professional development opportunities. Additionally, AGEP community participants resonated with the "sense of community" that is at the core of the MSU AGEP program legacy. In this article, we proposed a variation of Tomlinson's Graduate Student Capital model to describe the AGEP participants' perceptions and experiences in MSU AGEP. Within this 4-year period, we report over 70% graduation rate (completing with advanced degrees). More than half of Ph.D. students and almost 30% of master's degree students decided to pursue academia as their careers. In addition, we found a high satisfaction rate of AGEP among the participants. Our analysis on graduate student capital helped us identify motivating capital development by years spent at MSU and as an AGEP member. These findings may provide some insight into which capitals may be deemed important for students relative to their experiences at MSU and in AGEP and how their priorities change as they transition toward graduation.

A concept analysis of psychological safety: Further understanding for application to health care

AIM

To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care.

DESIGN

A Rodgers' concept analysis.

METHODS

The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web.

RESULTS

An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.

A Profile of Novice and Senior Nurses' Communication Patterns during the Transition to Practice Period: An Application of the Roter Interaction Analysis System

Novice nurses' successful transition to practice is impacted by their interactions with senior nurses. Ensuring that novice nurses are adequately supported during their transition to practice has wide-ranging and significant implications. The aim of this study is to explore the communication patterns between novice and senior nurses by applying an interaction analysis technique. Trimonthly onboarding evaluations between novice and senior nurses were recorded. The Roter Interaction Analysis System was adapted and deployed to identify communication patterns. In total, twenty-two interactions were analyzed. Senior nurses spoke more (64.5%). Task-focused exchange was predominant amongst senior (79.7%) and novice (59.5%) nurses. Senior nurses' talk was concentrated in clusters of information-giving (45%) and advice or instructions (17.2%), while emotional expression (1.4%) and social talk (0.4%) were rare. Novice nurses' talk was concentrated in clusters-information giving (57%) and positive talk (39.5%). The communication patterns between senior and novice nurses during the onboarding period indicate aspects of novice nurse transition that could be addressed, such as encouraging novice nurses to use these interactions to communicate more, or emphasizing the importance of social talk. These insights can be used to inform mentorship and preceptorship training to ensure that senior nurses are able to adequately support novice nurses through all parts of the transition to practice period.

Pre-licensure nursing students' experiences of psychological safety: A qualitative descriptive study

BACKGROUND

Organizational learning is essential for consistently providing safe, efficient, high-quality patient care. Psychological safety is foundational for organizational learning. For pre-licensure nursing students psychological safety is crucial for both their learning and patient safety. Understanding pre-licensure nursing students' experiences of psychological safety can guide efforts to cultivate clinical environments conducive to learning and excellent patient care.

OBJECTIVES

The objective of this study was to gain insight into pre-licensure nursing students' first-hand experiences with psychological safety in clinical settings.

DESIGN

A qualitative, descriptive design was used for this study.

SETTINGS

Participants were recruited from 12 different nursing programs across eight states.

PARTICIPANTS

A total of 26 pre-licensure nursing students participated in this study. Included were students who had completed at least one clinical rotation, but had not yet obtained licensure as a registered nurse.

METHOD

Semi-structured interviews were conducted via telephone. Interviews were analyzed using a constant comparative approach to thematic analysis.

RESULTS

Four primary themes emerged from the data, two of which had sub-themes: 1) Feeling Self-Conscious, with the sub-themes Expecting Expectations and Interpreting Feedback; 2) Engaging; 3) Learning and Performing; and 4) Moving Forward, with the sub-themes Using Coping Strategies and Developing Confidence.

CONCLUSIONS

This study reinforces the importance of psychological safety for nursing students' learning and for patient safety. Feeling psychologically safe allowed students to engage in the clinical setting, to learn from their experiences, and to perform their very best. With these insights, faculty and clinical preceptors can cultivate effective learning environments where patients can also receive safe, high-quality patient care.

Transition shock, preceptor support and nursing competency among newly graduated registered nurses: A cross-sectional study

BACKGROUND

Transition shock is highly prevalent among newly graduated registered nurses in their early career. Preceptors are widely used to support them in acquiring clinical nursing competencies and to promote their successful transition to practice. However, the mechanism by which transition shock and preceptor support are linked to nursing competency among newly graduated registered nurses remains unknown.

OBJECTIVES

The aim of the study was to examine the relationship between transition shock, preceptor support, and nursing competency in a sample of newly graduated registered nurses.

DESIGN

A descriptive, cross-sectional design.

SETTINGS

Six tertiary hospitals in the southeast of mainland China.

PARTICIPANTS

Newly graduated registered nurses undertaking their professional role in the first year.

METHODS

Convenience sampling was used to recruit 215 newly graduated registered nurses [184 female, 31 male] from six hospitals. Data on transition shock, preceptor support, and nursing competency were collected using questionnaires from November to December 2019.

RESULTS

The nursing competency of critical thinking/research aptitude (mean = 2.68, SD = 0.63) was scored the lowest among participants. Transition shock (r = -0.21, p < .01) and perceptions of preceptor support (r = 0.56, p < .01) were statistically significantly correlated with nursing competency. Preceptor context, whether the assigned preceptor varied day by day, and the emotional challenges of transition shock were the main predictors of nursing competency (F = 36.86, p = .00), accounting for 34% of the variance in nursing competency.

CONCLUSIONS

Educational programs aimed at increasing critical thinking and research aptitude in the educational stage and the continuing educational stage can benefit newly graduated registered nurses. A well-organized transition program in hospitals including awareness and recognition of transition shock in newly graduated registered nurses is essential to enhance their competency in providing quality nursing. More support and assistance would be useful in promoting the preceptor's role in improving nursing competency of newly graduated registered nurses.

Creating a Work Environment Conducive to Organizational Learning

Through organizational learning, health care teams can consistently provide excellent patient care in a complex and changing environment. Nurse managers, educators, and other leaders can facilitate organizational learning within their teams by promoting certain contextual factors in the clinical work environment. This article provides an overview of contextual factors associated with organizational learning, includes practice-based examples of these factors, and offers evidence-based recommendations for creating a learning-focused work environment. [J Contin Educ Nurs. 2021;52(6):281-285.].

Segurança do profissional e problemas éticos e bioéticos no cotidiano da atenção primária

O objetivo deste estudo é compreender os problemas éticos e bioéticos nas vivências de enfermeiros no cotidiano da atenção primária à saúde (APS) e seu impacto sobre a segurança do profissional. Trata-se de um estudo de casos múltiplos holístico-qualitativo, fundamentado na sociologia compreensiva do cotidiano, com 54 enfermeiros atuantes na aps. Apresenta dois casos definidos pelos cenários de duas capitais do sul do Brasil. Os dados foram submetidos à análise de conteúdo temática e à técnica analítica da síntese cruzada dos casos. Os resultados evidenciam que os problemas éticos e bioéticos se relacionam às precariedades do sistema e do atendimento, às condições de infraestrutura, ambiente e ambiência, e às fragilidades em torno das relações usuário-família- equipe, equipe-equipe e equipe-gestão, impactando negativamente na segurança do profissional. A segurança foi favorecida mediante a experiência e as habilidades adquiridas pelo enfermeiro em seu exercício profissional, a sistematização da assistência, os protocolos assistenciais, o uso de redes e mídias sociais, e a sensibilização das equipes por meio de espaços de discussão e capacitação referentes à ética e à bioética, e da atuação profissional segura. A compreensão da segurança do profissional enfermeiro, neste estudo, integra a objetividade que normatiza as condutas éticas e bioéticas, e a subjetividade de enfermeiros(as) ao apontar questtionamentos sobre sua segurança profissional perante sentimentos, angústias e anseios em sua prática cotidiana.

Silent Counterattack: The Impact of Workplace Bullying on Employee Silence

The purpose of this paper is to explore the relationship between workplace bullying (WB) and employee silence (ES) as well as its mechanism. This paper collects data from 322 employees of three Chinese enterprises in two waves, with a 2 months interval between the two waves. Moreover, this paper uses confirmatory factor analysis, a bootstrapping mediation test, a simple slope test, and other methods to verify the hypothesis. We find that: (1) WB is positively correlated with ES; (2) psychological safety (PS) and affective commitment mediated the relationship between WB and ES, respectively, and these two variables have a chain mediating effect in the above relationship; and (3) a forgiveness climate moderates this chain mediating effect by weakening the negative impact of WB on PS. Our findings can effectively guide organizations to ultimately adjust their management style, pay attention to employees’ cognitive and emotional resources, and formulate some measures to curb WB in organizations.