An evaluation of staff nurse role transition

Does Preceptorship improve confidence and competence in Newly Qualified Nurses: A systematic literature review

AIM

A systematic literature review to assess whether preceptorship improves confidence and competence in Newly Qualified Nurses.

BACKGROUND

Preceptorship was introduced into nursing in the United Kingdom in 1991 with the original aim to improve competence and confidence. This systematic review was undertaken to review the evidence of the impact of preceptorship on confidence and competence of nurses in their first year post qualifying.

DATA SOURCES

A comprehensive search of The British Nursing Index, CINAHL, Embase, Medline, PsycInfo, PyscArticles, Campbell Collaboration; Cochrane, HMIC, ERIC, ASSIA, Web of Science, Scopus, Scopus Conference, Web of Science Conferences; NHS Evidence, OpenGrey, National Technical, NINR, Opendoar, SSRN, Kings College London and the RCN was conducted.

METHODS

A PRISMA structured systematic review was carried out, 14 papers 4 mixed methods, 8 qualitative, 1 scoping review and 1 service development, published between 1996 and 2013 were critically reviewed, and data extracted using thematic analysis.

RESULTS

Four themes were identified from a thematic analysis: measurement, knowledge and experience, support, and structure.

CONCLUSION

While one-to-one preceptorship does influence confidence and competence, Preceptorship Programmes has greater impact than the individual preceptor. Due to limited empirical research there is no concrete evidence that Preceptorship has a direct impact on confidence or competence. Further research into team preceptorship/choice of preceptors and what impacts on Newly Qualified Nurses confidence and competence is required.

Developing a Preceptorship Programme for Newly Qualified Occupational Therapists: Action Research

This action research study used three focus groups and one interview to explore the experiences of five recently qualified occupational therapists, four supervisors and five occupational therapy managers. The participants were asked to identify the perceived development needs of new practitioners and the mechanisms that supported or hindered these being met.

The findings showed that the recently qualified occupational therapists experienced satisfaction at making a difference in their first posts. However, for some, their first post had fallen short of their expectations because they faced challenges when moving from student to practitioner, sometimes with limited support. The participants identified development needs that they felt were common to other new practitioners and also the factors that constrained or enabled the meeting of these needs.

These findings informed the second phase of the action research study to design a preceptorship programme that was compliant with the revised National Health Service employment contract (Department of Health 2005) and would improve the transitional experience of occupational therapists. This paper presents the focus group results and the rationale for the preceptorship programme, which was launched as a pilot evaluation study with occupational therapy staff from over 20 organisations in Autumn 2005.

Nursing a case of the blues: an examination of the role of depression in predicting job-related affective well-being in nurses

The current study explored the effect of depression, optimism, and anxiety on job-related affective well-being in 70 graduate nurses. It was predicted that depression and anxiety would have a significant negative effect on job-related affective well-being, whereas optimism would have a significant positive effect on job-related affective well-being. Questionnaires were completed online or in hard-copy forms. Results revealed that depression, optimism, and anxiety were all significantly correlated to job-related affective well-being in the expected direction, however, depression was found to be the only variable that made a significant unique contribution to the prediction of job-related affective well-being. Possible explanations for these findings are explored.

Stress and stressors in the clinical environment: a comparative study of fourth-year student nurses and newly qualified general nurses in Ireland

AIMS AND OBJECTIVES

To measure and compare the perceived levels of job-related stress and stressors of newly qualified nurses and fourth-year student nurses in the clinical environment and to explore the participants' views on stress and stressors.

BACKGROUND

Stress in the nursing workplace has significant consequences for the person, the patient and the organisation, such as psychological and physical health deterioration and impaired professional practice. To address this problem, stress and stressors need to be measured and identified.

DESIGN

This study used a cross-sectional survey design and self-reporting questionnaires to measure and compare levels of stress in both groups. Convenience sampling involved all newly qualified nurses (n = 120) and fourth-year student nurses (n = 128) in Dublin North-East region in Ireland.

METHODS

The instrument used was 'The Nursing Stress Scale' (Gray-Toft & Anderson 1981, Journal of Behavioral Assessment 3, 11-23). Descriptive, qualitative analysis was conducted on an open-ended question. Data were obtained from newly qualified nurses (n = 31) and fourth-year student nurses (n = 40) in six acute hospital sites.

RESULTS

Levels of perceived stress and stressors were high in both groups. Themes identified from the responses to the open question by both groups included excessive workload, difficult working relationships and unmet clinical learning needs. Student nurses also reported the combination of academic demands with clinical placement as a major stressor. There was no significant difference between each group.

CONCLUSION

Stress continues to be a problem for nurses in the clinical setting. Excessive workload requires urgent attention by hospital managers in view of widespread retention difficulties. Themes identified could provide a framework for possible interventions for improving the clinical environment for nurses.

RELEVANCE TO CLINICAL PRACTICE

These results can help stakeholders in nurse education and practice to develop interventions to reduce stress for both groups and to ease the transition from student to graduate nurse.

Perceptions within a mentorship program

PURPOSE/OBJECTIVES

The purpose of this study was to examine the experiences of mentees and mentors in a structured mentorship program.

DESIGN

A qualitative study using focus group methodology in a nonrandom purposive sample was used.

SETTING

The study was conducted at a level 1 university-affiliated hospital within a 9-bed cardiothoracic intensive care unit.

SAMPLE

Mentors were identified as Clinical Nurse III's within the institution's clinical ladder. Mentees were identified as Clinical Nurse I's who had no previous critical care nursing experience. To meet inclusion criteria, mentors and mentees had to be paired for at least 10 months before the study. All mentors participated in the study (n = 6) and all but 1 mentee participated (n = 5).

FINDINGS

Results of this study revealed the following shared perceptions from the mentees and mentors: (1) availability, (2) sense of community, and (3) support and knowledge.

CONCLUSIONS

This study suggests that mentees and mentors undergo similar experiences and perceptions in a mentorship program despite different roles.

IMPLICATIONS

Mentorship programs create a unique environment that facilitates the educational opportunities for both the novice and expert clinician.

Clinical supervision: The way forward? A review of the literature

A discussion of clinical supervision to enhance existing support structures such as preceptorship and mentorship to positively influence the recruitment and retention of newly graduate nurses provides the main focus for this paper. The nursing literature provides evidence for alternative but equally worthy perspectives on clinical supervision. Essential to the successful practice of clinical supervision is the need to ascertain whether it is simply a system to ensure an effective workforce or one that will empower nurses to realise their vision of nursing.

The first year as a graduate nurse--an experience of growth and development

AIM

The aim of this paper was to illuminate how recently graduated nurses experience their first year as a nurse.

BACKGROUND

Graduate nurses are expected to identify themselves as members of an interdisciplinary team, to feel comfortable in chaos and to make and defend decisions. By graduation nurses expect to have the necessary competence to perform nursing. Recently graduated nurses lack competence, especially relating to leadership.

DESIGN

A qualitative design was chosen and 12 nurses working in hospitals and home care were individually interviewed.

METHOD

The interviews were transcribed verbatim and the texts were analysed using manifest and latent content analysis.

RESULTS

The nurses gave descriptions covering numerous experiences, interpreted and categorised in the following eight subcategories: uncertainty and chaos; need for induction; need for a supportive environment; need for recognition; awareness of responsibility; need for positive experiences; becoming experienced; and managing challenges. These subcategories gave reason for the three categories: experience of being new; gaining nurse experience; and gaining competence. The nurses described a tough start as a nurse, but they most of all gave descriptions interpreted as an experience of growth and development, which constituted the theme in this study.

CONCLUSIONS

Recently graduated nurses have a positive attitude to the challenges of being a new nurse. Although the initial period as a nurse was tough, the nurses appreciated their experiences because they learnt from them.

RELEVANCE TO CLINICAL PRACTICE

Recently graduated nurses should be spared from being the only nurse on duty. Employers both in hospital and home care should facilitate induction programmes for new graduate nurses.

Fostering maturity for senior nursing students: a pre-graduation clinical placement

BACKGROUND

There is considerable literature on graduates' role transition to registered nurse from the employer's perspective. Few studies have discussed issues and strategies related to nursing students' preparedness. In response to the Bachelor of Nursing (Honours) senior nursing students' needs in terms of role transition, a pre-graduation clinical placement (PGCP) was implemented.

AIM

The aim of this paper is to report the learning experiences and outcomes of the PGCP.

METHODS

Both quantitative and qualitative approaches were used. All students (n=37) and preceptors (n=33) involved in the PGCP consented to participate in summer 2002. The data included: students' and preceptors' appraisal of pre- and post-Inventory for Nursing Competencies (INC), students' formative and summative reflective journals, and post-PGCP focus group interviews. Paired t-tests were done to compare students' and preceptors' pre- and post-INC scores, and thematic analyses were carried out for qualitative data.

RESULTS

There were statistically significant improvements in students' INC. Three themes - learning to work with ward nurses and preceptors, learning total aspects of care, and acting as RNs - were revealed.

CONCLUSION

The success of the PGCP demonstrates the promising outcome of a long consolidating clinical block prior to graduation in fostering maturity for role transition.

Newly qualified Irish nurses' interpretation of their preparation and experiences of registration

AIMS AND OBJECTIVES

The aim of this paper is to report on the insights of newly qualified Irish nurses into their preparation for registration as general nurses and to develop insights into the postregistration experience.

BACKGROUND

Nurse education in Ireland has undergone much reform over the past decade. These changes include the introduction of supernumerary status for nursing students and the formation of links with institutes of higher education. No Irish literature was found on this subject.

METHOD

Individual semi-structured, in-depth interviews were held with 12 newly registered nurses, from two cohorts, within 10 months of qualification. A grounded theory approach was adopted and content analysis employed to analyse the data.

RESULTS

Two categories, entitled Learning the Ropes and The Metamorphosis emerged from the analysis of data. Within each of these categories there were two subcategories. All respondents reported that since qualification, they had become increasingly conscious of their isolation and unmet needs as nursing students. Postregistration, they enjoyed their increased status and widespread recognition by others.

CONCLUSIONS

This study details how improvements can be made at clinical level to assist the preparation of nursing students for registration. The positive aspects of registration are revealed through descriptions of comparisons of pre- and postregistration experiences, while the shortcomings of the journey to registration are described.

RELEVANCE TO CLINICAL PRACTICE

Pre-registration nurses have unmet clinical needs which, if fulfilled, would benefit them post-registration. Good ward morale is elementary for student learning and enhances the post-registration experience. Registered nurses are highly conscious of their altered status. These findings are pertinent to clinicians and educationalists as they prepare nursing students for practice.

Facing registration: the expectations and the unexpected

This paper reports on newly qualified nurses' experiences of the transition from being a nursing student to becoming a registered nurse. The aim of the study was to ascertain how newly qualified nurses perceived their role transition in an Irish general hospital. Data were gathered using in-depth interviews with 12 nurses who were within one year of qualification. A grounded theory approach was used to generate, analyse and synthesise the data. The findings revealed that newly qualified nurses have specific needs, many of which are unrealised. The vast and increased workload, which involved less patient-contact and more non-nursing duties, came as a surprise to participants in this study. The expectation of in-depth knowledge, coupled with feelings of increased responsibility and compounded by relatively little experience did little to ease the transition to becoming a newly qualified nurse. There is a need to contextualise the transition to registration so that expectations of newly qualified nurses are realistic. Management and staff must remain cognisant of the fact that many newly registered nurses have relatively limited clinical experience at the time of registration.

The lived experiences of newly qualified nurses on clinical placement during the first six months following registration in the Republic of Ireland

AIM

To explore the lived experiences of newly qualified nurses on clinical placement, during the first six months following registration, in the Republic of Ireland.

BACKGROUND

The subject of the experiences of newly qualified nurses is not generally well researched, although anecdotal articles are plentiful. In particular, the lived experiences of newly qualified diploma nurses in the Republic of Ireland are not reflected in the research literature. However, available literature on the subject clearly demonstrates that being a newly qualified staff nurse is particularly stressful and many nurses feel unprepared for the staff nurse role.

DESIGN

A phenomenological, Heideggerian, hermeneutic approach was used for this study.

METHODS

Ten diplomate staff nurses were interviewed and the data were analysed using a thematic analysis framework.

RESULTS

Newly qualified nurses in the Republic of Ireland describe their initial experiences of being on the ward as stressful. This stress is primarily related to the multi-dimensional responsibilities associated with the new role and to managerial/organizational/clinical skills deficits. The allocation of students and dealing with situations that they felt unprepared for added to their anxieties. However, diplomate nurses were willing to acknowledge these limitations and seek help when appropriate. Feeling valued, making a difference and financial reward were cited as being the positive aspects of the new role.

RELEVANCE TO CLINICAL PRACTICE

The preregistration nurse education curriculum needs to be developed further to help alleviate the problems associated with the initial transition to the staff nurse role. In addition, effective supportive systems need to be introduced for newly qualified nurses to help ensure that they are prepared for and supported in their professional role.

Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement

Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area.

Professional socialization: The key to survival as a newly qualified nurse

The impact and prevalence of professional socialization in nursing has been written about extensively. Despite the many positive developments that have taken place in nursing within the past decade, the role of professional socialization remains heavily weighted and is of particular significance to those nurses who are newly qualified. The account given by newly registered nurses in this study demonstrates that their ability and willingness to become professionally socialized determines their ease of survival at clinical level. Twelve newly qualified Irish nurses, from two separate cohorts, were interviewed to ascertain their perceptions of becoming newly qualified nurses. A grounded theory approach was used and data were analysed using thematic analysis. A category that emerged was linked very strongly with professional socialization. The respondents did not refer to professional socialization per se, but through the coding process this emerged as the linchpin of the discussion.

The transition from student to qualified nurse: a militaryperspective

This article explores some of the issues surrounding my transition from student nurse to qualified Royal Air Force staff nurse. It supports much of the research showing that the transition to staff nurse is stressful, with the time for preceptorship and supernumerary status varying. The education and support received during this period is still largely dependent on staff availability and this remains an area of concern. For military nurses the transition period is extra challenging, as there are military as well as nursing demands. This includes working predominantly in a civilian environment, while being aware that we may be deployed overseas with the military. However, the ability to adapt and adjust to changing circumstances is what essentially makes military nurses unique and distinctive. Provided that support is in place and appropriate clinical experience is obtained, we can fulfil our primary military roles.

Development of a mentorship programme for new graduate nurses in mental health

A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper.

Facilitating Role Transition for New Graduate RNs in a Semi-Rural Healthcare Setting

This study describes and evaluates a structured program for orientation of new graduate registered nurses in a setting that has increased the number of new graduate RNs hired in recent years. It describes the elements of a supportive environment for new RNs and brings attention to the need to develop support and recognition of nurse preceptors, who are noted to be the cornerstone of support for new RNs as they make the transition from student to accomplished professional.

Effects of ward rotation on subsequent transition processes of Japanese clinical nurses

The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In-depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well-prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.

The experience of marginalization in new nursing graduates

This article discusses the conceptual history of marginalization, suggesting its use as a framework within which to understand some of the causal relationships between the high rate of attrition of new nursing graduates from professional nursing and the difficulties incurred during their transition from student to professionally practicing nurse. The application of marginalization in this article focuses on the vulnerability and alienation that these newly graduated nurses experience during their introduction to acute-care practice. The article further suggests that they are both inadequately prepared by their undergraduate education to enter into the full scope of their new role as professional practitioners, and ineffectually orientated to an oppressive workplace culture that they are expected to sustain.