A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse

Glimpses into the transition world: New graduate nurses' written reflections

BACKGROUND

This study was born out of our reflections as educators responsible for helping new graduate nurses transition into their first year of professional practice through a formal education programme. Finding ourselves wondering about many of the questions the students raised with us, we set about looking more closely at what could be gleaned from the students' experience, captured in their written work over the course of a year.

OBJECTIVES

To identify the challenges and learning experiences revealed in reflective assignments written by new graduate nurses undertaking a postgraduate course as part of their transition to registered nurse practice.

STUDY DESIGN, SETTING AND PARTICIPANTS

Data consisted of the written work of two cohorts of students who had completed a postgraduate university course as part of their transition to new graduate practice in New Zealand. Fifty four reflective essays completed by twenty seven participating students were collected and their contents analysed thematically.

RESULTS

Five key themes were identified. The students' reflections noted individual attributes - personal and professional strengths and weaknesses; professional behaviour - actions such as engaging help and support, advocating for patients' needs and safety and putting their own feelings aside; situational challenges such as communication difficulties, both systemic and interpersonal, and the pressure of competing demands. Students also identified rewards - results they experienced such as achieving the nursing outcomes they desired, and commented on reflection as a useful tool.

CONCLUSIONS

The findings shed light on the experiences of new graduates, and how they fare through this critical phase of career development. Challenges relating to the emotional labour of nursing work are particularly evident. In addition the reflective essay is shown to be a powerful tool for assisting both new graduate nurses and their lecturers to reflect on the learning opportunities inherent in current clinical practice environments.

Feeling Safe and Taking on Responsibilities: Newly Graduated Nurses' Perceptions and Evaluations of Their Transition Into a Forensic Mental Health Inpatient Setting

Forensic mental health care is faced with serious problems in the recruitment and retention of newly graduated nurses (NGNs). Research into NGNs' experiences of their transition to and evaluations of transition programs in forensic care is sparse, and more studies are called for. This study aimed to investigate the characteristics of NGNs' experiences and perceptions of their transition into a forensic setting and their evaluations of the introduction period. Three focus group interviews were carried out, involving 13 NGNs, lasting 79.68 minutes on average. They were analyzed using thematic analysis. Results show two main themes: "feeling safe" and "taking on responsibilities." If NGNs felt overburdened with clinical responsibilities during their transition, their feeling of safety reduced. The converse also applied; theThe safer they felt, the greater clinical responsibility they felt capable of handling. The more difficult the NGNs perceived the informal transition, the more unsafe they felt, and the more negatively they perceived the responsibilities placed upon them. Tailored programs designed to support both the informal and formal transitions are recommended, along with preceptorship, theoretical training, and role-based support, such as a shift manager, along with early introduction to conflict management and security measures.

Newly Licensed RN Retention: Hospital and Nurse Characteristics

OBJECTIVES

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence.

METHODS

A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience.

RESULTS

The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay.

CONCLUSION

Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Facilitating the transition from a nursing student to a Registered Nurse in the final clinical practicum: a scoping literature review

BACKGROUND

Transition from a nursing student to a Registered Nurse is a stressful and challenging process. Different postgraduate residency and orientation programmes have been developed to ease the first year of employment, but less attention has been paid to pregraduate programmes and how the final clinical practicum of nursing education should be conducted to facilitate this transition.

AIM

To review the empirical studies concerning interventions that aim to facilitate the transition from nursing student to Registered Nurse in the final clinical practicum of nursing education. The aim was to scrutinise the structures and contents of the interventions and factors connected with the facilitated transition.

METHOD

A scoping literature review was conducted with systematic searches in three electronic databases: CINAHL, MEDLINE and ERIC. The searches were limited to studies that were written in English, had available abstract and were published between 2005 and 2016. Two researchers assessed the studies regarding their eligibility with reference to the inclusion and exclusion criteria, and 17 articles were included in this review. Inductive content analysis was used to categorise the contents of studies.

RESULTS

The structures of the interventions described included: the participation, learning environment, amount of clinical work, supervisor criteria and supervision methods. The contents of the interventions included supervisor support, transition supportive learning activities and the student's practicum duties. The factors that were connected with facilitated transition were the quality of the supervision, adjusting to a professional nurse's role, achieved comfort and confidence and achieved competence.

CONCLUSION

This scoping review offers insight into the diversity of interventions facilitating transition implemented in the final clinical practicum of nursing education. In order to unify these practices and determine the elements necessary to include, studies with stronger designs need to be conducted.

Promoting the legitimacy and agency of new graduate nurses' participation in nursing research

AIM

This paper explores the legitimacy and agency of new graduate mental health nurses to participate in research activities as a regular part of their professional nursing role.

BACKGROUND

There is a wealth of literature describing personal and organisational factors that act as barriers to nurses' engagement in research and overcoming these barriers remains a challenge for health organisations. Some new graduate nurses are well positioned to contribute to research and yet the literature has given little attention to this specific cohort.

RESULTS

This paper will show how facilitating new graduates' participation in research benefits the new graduate and the health service.

CONCLUSION

New graduates learn research skills from experienced researchers and this ensures a sustainable future workforce of researchers. Employers who support staff to pursue professional challenges such as research are more likely to generate organisational commitment and loyalty amongst staff.

Integrating Retired Registered Nurses Into a New Graduate Orientation Program

PURPOSE

The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area.

DESCRIPTION OF PROJECT

All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues.

OUTCOME

All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA.

CONCLUSION

Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.

Development and Psychometric Properties of the Nursing Critical Thinking in Clinical Practice Questionnaire

BACKGROUND AND AIM

A complex healthcare environment, with greater need for care based on the patient and evidence-based practice, are factors that have contributed to the increased need for critical thinking in professional competence. At the theoretical level, Alfaro-LeFevre () put forward a model of critical thinking made up of four components. And although these explain the construct, instruments for their empirical measurement are lacking. The purpose of the study was to develop and validate the psychometric properties of an instrument, the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice), designed to evaluate the critical thinking abilities of nurses in the clinical setting.

METHODS

A cross-sectional survey design was used. A pool of items was generated for evaluation by a panel of experts who considered their validity for the new instrument, which was finally made up of 109 items. Following this, validation was carried out using a sample of 339 nurses at a hospital in Barcelona, Spain. Reliability was determined by means of internal consistency and test-retest stability over time, although the validity of the construct was assessed by means of confirmatory factor analysis.

RESULTS

The content validity index of the N-CT-4 Practice was .85. Cronbach's alpha coefficient for the whole instrument was .96. The intraclass correlation coefficient was .77. Confirmatory factor analysis showed that the instrument was in line with the four-dimensional model proposed by Alfaro-LeFevre ().

LINKING EVIDENCE TO ACTION

The psychometric properties of theN-CT-4 Practice uphold its potential for use in measuring critical thinking and in future research related with the examination of critical thinking.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice

AIM

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles.

BACKGROUND

Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services.

METHOD

A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces.

RESULTS

New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads.

CONCLUSIONS

The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Specialist Bibliographic Databases

Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls.

Development of a situational initiation training program for preceptors to retain new graduate nurses: Process and initial outcomes

BACKGROUND

Most preceptor training programs consist of classroom-based courses, and only a few programs are conducted using films. Preceptors have identified most training courses as inapplicable in various clinical situations.

OBJECTIVES

To describe the systematic development of a situational initiation training program (SITP) for preceptors and to evaluate its impacts on the stress levels of preceptors and new graduate nurses (NGNs), the preceptor-NGN relationship, support provided by preceptors to NGNs, and the intention to leave among NGNs during a 1-year preceptorship.

DESIGN

The conceptual framework of development, implementation, and evaluation was used for program completion.

PARTICIPANTS AND SETTINGS

Preceptors and NGNs working at a teaching medical center in Taipei participated.

METHODS

The 1-day SITP workshop comprised four films, reflection time, and four classroom-based courses. Training outcomes were evaluated using a questionnaire survey for preceptors and NGNs at months 3, 6, 9, and 12 after employing the NGNs. Data were analyzed using descriptive statistics and analysis of variance with repeated measures.

RESULTS

The annual turnover rate of NGNs was 10.5%. During the first preceptorship year, the NGNs reported moderate stress levels, good to excellent relationships with their preceptors, moderate to excellent support from their preceptors, and low intention to leave their current jobs. Similarly, preceptors reported moderate stress levels, except at month 12 (mean=4.8), and good to excellent relationships with their NGNs. The SITP considerably improved the preceptor-NGN relationship for both NGNs and preceptors, whereas no improvement was observed in the stress levels, except in the stress levels of preceptors.

CONCLUSIONS

The SITP is clinically effective for preceptors; thus, nurse educators may apply the SITP for redesigning the existing preceptor training programs to develop highly skilled preceptors and improve training outcomes.

The effectiveness and implementation of mentoring program for newly graduated nurses: A systematic review

BACKGROUND

Newly graduated nurses suffer from occupational stress during the transition from school to employment as a result of inadequacy, interpersonal relationships, and the overwhelming workload. Mentoring programs have proved effective in facilitating this transition.

OBJECTIVES

To evaluate the effectiveness of a mentoring program on the mentor, mentee, and organization.

METHODS

The Cochrane Library, Medline, Ovid, Elsevier, Embase, CINAHL, CBM, CNKI, and WanFang Data databases were searched to identify relevant publications in English or Chinese up to October 2014.

DESIGN

This is a systematic review.

RESULTS

This review identified nine potentially eligible studies, and the methodological quality levels of the included studies were all ranked as level B. These studies revealed that the turnover rate can be decreased through a mentoring program. Additionally, mentoring can enhance nursing competency and establish a supportive workforce environment, resulting in positive outcomes.

CONCLUSION

This review reveals that a mentoring program has positive effects on the mentors, mentees, and organizations. A successful mentorship program should include rigorous mentor selection and adequate training. Additionally, potential barriers such as time constraints and scheduling limitations should be taken into consideration during implementation.

Reaching their potential: Perceived impact of a collaborative academic-clinical partnership programme for early career nurses in New Zealand

BACKGROUND

The dynamic nature of healthcare ensures that early career nurses enter an uncertain and complex world of practice and consequently require support to develop their practice, build confidence and reach their potential. The New Zealand Nurse Entry to Practice programme for registered nurses in their first year of practice has been operating since 2005 to enable safe and confident practice, improve the quality of care, and positively impact on recruitment and retention. This academic and clinical programme was offered as a partnership between a university and a clinical provider with postgraduate academic credits gained.

AIM

The aim of this study was to explore the perceived impact of postgraduate university education for early career nurses in one regional health area of New Zealand.

METHODS

Participants were registered nurses who had completed the early career nurse programme and their clinical preceptors. The research was conducted via an online survey of 248 nurses and three focus groups to explore how the programme was experienced and its impact on knowledge and practice.

RESULTS

Early career nurses and their preceptors found that the programme enables improved knowledge and skills of patient assessment, application of critical thinking to clinical practice, perceived improvement in patient care delivery and outcomes, enhanced interprofessional communication and knowledge sharing, and had a positive impact on professional awareness and career planning.

CONCLUSIONS

This clinical-academic partnership positively impacted on the clinical practice and transition experience of early career nurses and was closely aligned to an organization's strategic plan for nursing workforce development.