Support for nurses who are new to emergency care

Signs of Severity (SOS) ED Escalation Guide: Bridging the Experience Gap

INTRODUCTION

This study evaluated the introduction of an ED Escalation Guide (EDEG) as an early warning system for the many new graduate nurses in the emergency department. The EDEG is a chart that provides ED-appropriate parameters to prioritize both vital signs and critical symptoms. Scenario quizzes were used to evaluate its usefulness.

METHODS

Comparative quizzes that required prioritizing the urgency of patient symptoms were given to emergency nurses with varying levels of experience, with and without the use of the EDEG. The quizzes, with scenarios adapted from the Emergency Severity Index (ESI) Handbook, were given to ED RNs 1 week apart; the second quiz included availability of the EDEG. Scores were compared based on demographic data that included years of ED experience and clinical expertise.

RESULTS

RNs with less than 1 year of ED experience showed a 29% improvement in scenario scores with use of the EDEG. Those with more experience had similar scores with and without the availability of the guide, but increasing experience led to higher scores. A log kept by new emergency nurses using the EDEG showed accuracy and greater confidence in notifying ED physicians.

DISCUSSION

RNs with less than 1 year of ED experience might not recognize or report critical symptoms without a guide. The EDEG helps new emergency nurses to prioritize the urgency of clinical symptoms better and gives them the confidence to report these clinical symptoms. Early warning systems, such as the EDEG, can be valuable tools for inexperienced emergency nurses.

Transition to Specialty Practice Program characteristics and professional development outcomes

BACKGROUND

Transition to Specialty Practice Programs was introduced to facilitate the transition of nurses to specialty practice, and is recognised as preparatory for emergency nurses. Emergency nursing Transition to Specialty Practice Programs and their characteristics have developed locally in response to unit needs.

OBJECTIVE

The aim of this study was to examine the characteristics of emergency nursing Transition to Specialty Practice Programs in Australia, and identify which characteristics were associated with improved professional development outcomes.

METHODS

An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Managers and Nurse Educators. Transition to Specialty Practice Program characteristics were compared using Mann Whitney U and Chi-Square tests. Content analysis was used to analyse qualitative data.

RESULTS

Survey data were collected from 118 emergency departments, and 13 interviews were conducted. Transition to Specialty Practice Programs were offered in most emergency departments (n=80, 72.1%), with one or two intakes per year. Transition to Specialty Practice Program characteristics varied; duration ranged from 5-12months, clinical preparation time ranged from 7-22days, and the number of study days provided ranged from 2-6. When Transition to Specialty Practice Programs of 6 and 12months duration were compared, there was no difference in the content covered. Emergency departments with 12month Transition to Specialty Practice Programs had lower percentages of Clinical Specialists (9% vs 18%, p=0.03) and postgraduate qualified nurses (30.5% vs 43.8%, p=0.09).

CONCLUSION

The target participants, duration and clinical preparation of Transition to Specialty Practice Programs participants varied, impeding workforce mobility and articulation to postgraduate study and there were no professional development advantages from longer programs. There is an urgent need for a nationally consistent, evidence-based and fiscally responsible approach to Transition to Specialty Practice Programs.

The effect of Transition to Specialty Practice Programs on Australian emergency nurses' professional development, recruitment and retention

BACKGROUND

To date, emergency nursing Transition to Specialty Practice Program (TSPP) evaluations have been single-site observational studies. The aim of this paper was to examine the professional development, recruitment and retention outcomes of Australian emergency nursing TSPPs.

METHODS

An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Unit Managers and Nurse Educators. Survey data from EDs with TSPPs and EDs without TSPPs were compared. Qualitative data were analysed using content analysis.

RESULTS

Data were collected from 118 EDs, and 13 interviews. TSPPs were offered in 72.1% of EDs. EDs with TSPPs had higher proportions of nurses with postgraduate qualifications (Mdn 28.3% vs. 22.1%, p=0.45) and Clinical Specialists (Mdn 16.4% vs. 6.3%, p=0.04). The median proportion of currently rostered nurses with TSPP completion was 34.2% in EDs with TSPPs introduced in 2000-2005 indicating ED high levels of retention.

CONCLUSION

Emergency nursing TSPPs have had a positive effect on nursing professional development, recruitment and retention. To ensure consistency in outcomes and optimise reliability of emergency nursing skills and knowledge, a national emergency nursing TSPP framework is needed.

Identifying and acquiring the contextual skills and knowledge for nursing practice in assisted reproductive technology: a grounded theory study

AIMS AND OBJECTIVES

To identify the contextual knowledge and skills required for practice.

BACKGROUND

Nursing practice in assisted reproductive technology (ART) makes a significant contribution to patient care. Despite this, the knowledge and skills integral to this area of practice have not been clearly articulated, particularly from an Australian perspective.

DESIGN

A constructivist grounded theory design was used to gain the perspective of ART nurses in relation to how they understood their clinical practice as well as the issues and challenges that they faced.

METHODS

Individual in-depth interviews were undertaken with 15 registered nurses working in ART units across Australia. Constant comparative data analysis was used to determine the main categories.

RESULTS

Contextual knowledge and skills was one category to emerge from this research, and this is the focus of this paper. The findings in respect of knowledge and skill included three main subcategories: required skills and knowledge; acquisition of skills and knowledge; and factors influencing acquisition.

CONCLUSIONS

The role of the ART nurse which must be performed within the context and competency standards of nursing requires a framework that could define and contribute to specialised ART nursing practice standards.

RELEVANCE TO CLINICAL PRACTICE

The nursing role is instrumental to effective ART treatment and care. The standard of clinical practice will depend in part on the ability of specialist nurses to articulate their practice, and their professional development needs to optimise quality and effectiveness. The results of this study demonstrate that contextual knowledge and skills are a key aspect of this specialised nursing role.

The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse

EXECUTIVE SUMMARY

Background: The transition period from student to newly qualified nurse where nurses are adjusting to their new role and consolidating their knowledge and skills can be stressful. It is a time when many newly qualified nurses are left feeling inadequately prepared. A variety of strategies to ease the transition process have been reported, which aim to increase confidence, competence, sense of belonging of new graduates, improve recruitment and retention and reduce turnover costs.

OBJECTIVES

To synthesise the best available evidence on the effectiveness of support strategies and interventions aimed for newly qualified nurses.

METHODS

A comprehensive search was undertaken on major electronic databases to identify both published and unpublished studies from 2000 to the present date. Reference lists of retrieved papers were searched and authors contacted. Only quantitative studies published in English language were considered.Methodological quality and data extraction: Two reviewers independently assessed methodological quality and extracted data from the included studies. A third reviewer resolved any disagreements through discussion.

DATA SYNTHESIS

The review did not identify comparable Randomised Controlled Trials (RCTs), and as such meta-analysis of the data was not appropriate. The data extracted from the included studies were synthesized into a narrative summary.

RESULTS

Thirty three studies were included in the review: RCT (1), Quasi-experimental (3) and observational/descriptive studies (29). Countries of origin were: USA (25), Australia (4), England (2), New Zealand (1) and Thailand (1). Studies were categorised according to the type of programme or support strategy provided: nurse internship/residency programmes (14) and graduate nurse orientation programmes (7), preceptorship (4), simulation (3) and mentoring (2), final year nursing students transition programs (2) and externship (1).Outcomes were categorised as being important to the employer (recruitment, retention, turnover rates, competence, confidence and costs), or to the new graduate (stress and anxiety reduction, job satisfaction, knowledge/skills acquisition, critical thinking and interpersonal skills, confidence and professional nursing behaviours).

CONCLUSIONS

The range of outcomes reported across the studies made it difficult to report firm conclusions. A general increase in level of confidence was noted, along with reduction in stress and anxiety. Some success in relation to increases in knowledge, critical thinking and levels of job satisfaction were reported. A number of studies reported a V shaped pattern (initial high levels, dipping at 6 months and then reverting to baseline levels) for autonomy, job satisfaction, and professional transition. Research relating to improvements in retention and reduction in turnover was generally poor.

IMPLICATIONS FOR PRACTICE

The overall impact of intervention programmes appears positive, irrespective of the intervention. This may suggest that it is the organisation's focus on new graduate nurses with support from colleagues that is important. .Mentors/preceptors need to be adequately prepared for the role.

IMPLICATIONS FOR FUTURE RESEARCH

Future research should build on the strengths and limitations of the current studies. A lack of experimental studies means there is commonly little control over other variables that might influence the outcome. There is a need for larger studies using more objective and reliable measures.