An assessment continuum: How healthcare professionals define and determine practice readiness of newly graduated registered nurses

Current nursing and midwifery contribution to leading digital health policy and practice: An integrative review

AIM

To review the current nursing and midwifery contribution to leading digital health (DH) policy and practice and what facilitates and/or challenges this.

DESIGN

Integrative literature review.

METHODS

Pre-defined inclusion criteria were used. Study selection and quality assessment using the appropriate critical appraisal tools were undertaken by two authors, followed by narrative synthesis.

DATA SOURCES

Six databases and hand searching for papers published from 2012 to February 2024.

FINDINGS

Four themes were identified from 24 included papers. These are discussed according to the World Health Organization's Global Strategic Directions for Nursing and Midwifery and indicate nurses/midwives are leading DH policy and practice, but this is not widespread or systematically enabled.

CONCLUSION

Nurses and midwives are ideally placed to help improve health outcomes through digital healthcare transformation, but their policy leadership potential is underused.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses/midwives' DH leadership must be optimized to realize maximum benefit from digital transformation. A robust infrastructure enabling nursing/midwifery DH policy leadership is urgently needed.

IMPACT

This study addresses the lack of nursing/midwifery voice in international DH policy leadership. It offers nurses/midwives and health policymakers internationally opportunity to: drive better understanding of nursing/midwifery leadership in a DH policy context; enhance population outcomes by optimizing their contribution; Develop a robust infrastructure to enable this.

REPORTING METHOD

Reporting adheres to the EQUATOR network, Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Job satisfaction, professional competence, and self-efficacy: a multicenter cross-sectional study among registered nurses in Sweden and Norway

BACKGROUND

Healthcare organizations worldwide face persistent challenges relating to turnover and intention to leave the nursing profession among registered nurses. Factors contributing to their retention and well-being at work include high job satisfaction, professional competence, and self-efficacy. Few multicenter studies have investigated these factors in relation to work experience in a Nordic context. Therefore, this study aimed to investigate job satisfaction, professional competence, and self-efficacy among registered nurses.

METHODS

This multicenter cross-sectional study survey was part of a larger overarching Swedish-Norwegian project, and was conducted among registered nurses (n = 1137) in September 2021. The participants worked in a variety of health care units, e.g., hospital units, primary health care, and home care. Data was subjected to descriptive and comparative statistical analysis; chi-square test, one-way between-groups analysis of variance (ANOVA) and Kruskal-Wallis test.

RESULTS

The findings show that job satisfaction is reported as lowest in registered nurses with medium-term work experience as compared to newly qualified and long-term work-experienced registered nurses. Professional competence and self-efficacy are reported as higher among registered nurses with long-term work experience as compared to those with medium-term work experience and newly qualified registered nurses. However, the participants reported their professional competence as highest in relation to the same factor - "Value-based nursing care" - regardless of their work experience.

CONCLUSIONS AND IMPLICATIONS

This study underscores the need for continuous support and professional development for registered nurses throughout their careers. Proactive support for newly qualified nurses may improve job satisfaction as they progress to being registered nurses with medium-term work experience. Tailored interventions to address the distinct needs of both newly qualified and medium-term work-experienced registered nurses are crucial for nurturing a sustainable nursing workforce.

Factors associated with practice readiness among newly qualified nurses in their first two years of practice

BACKGROUND

Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession.

OBJECTIVES

To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession.

DESIGN

A cross-sectional study.

SETTINGS AND PARTICIPANTS

A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore.

METHODS

Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice.

RESULTS

More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03).

CONCLUSIONS

It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.

Nursing students' experience of bullying and/or harassment during clinical placement

PROBLEM OR BACKGROUND

Bullying is a recognised problem in nursing. Nursing students are particularly vulnerable. Bullying and harassment of nursing students can be detrimental to both students and recipients of care.

AIM

This study aims to identify the incidence and nature of bullying and/or harassment experienced by nursing students in Sri Lanka.

METHODS

A cross-sectional survey consisting of eight demographic questions and 15 items specific to the experience of bullying and harassment was administered to nursing students online.

FINDINGS

A total of 656 students from 26 nursing education institutions in Sri Lanka participated. The majority were female with a mean age of 24.4 years. More than a quarter of respondents reported that they had experienced bullying and/or harassment while on clinical placement, with a further 16.7 % being unsure. Most bullying or harassment (55 %) occurred in hospitals with 29 % experienced in community settings. Registered nurses, including nurse managers and clinical facilitators were the most common perpetrators. Verbal abuse was the most frequent type of behaviour reported.

DISCUSSION

These findings support existing literature that indicates that bullying of nursing students is an international phenomenon. The context of this study provides clues as to how culture may influence the problem. There is a need to better understand bullying and harassment in the environments in which it occurs, in order to identify strategies that can bridge cultures and settings.

CONCLUSION

The incidence of bullying and harassment of nursing students in Sri Lanka is concerning. Further research is needed to identify and evaluate targeted strategies to help prevent negative outcomes in all nursing contexts.

Defining Practice Readiness in Pediatric Surgery Fellowship: A Qualitative Analysis

INTRODUCTION

While competency-based training is at the forefront of educational innovation in General Surgery, Pediatric Surgery training programs should not wait for downstream changes. There is currently no consensus on what it means for a pediatric surgery fellow to be "practice-ready". In this study, we aimed to provide a framework for better defining competency and practice readiness in a way that can support the Milestones system and allow for improved assessment of pediatric surgery fellows.

METHODS

For this exploratory qualitative study, we developed an interview guide with nine questions focused on how faculty recognize competency and advance autonomy among pediatric surgery fellows. Demographic information was collected using an anonymous online survey platform. We iteratively reviewed data from each interview to ensure adequate information power was achieved to answer the research question. We used inductive reasoning and thematic analysis to determine appropriate codes. Additionally, the Dreyfus model was used as a framework to guide interpretation and contextualize the responses. Through this method, we generated common themes.

RESULTS

A total of 19 pediatric surgeons were interviewed. We identified four major themes from 127 codes that practicing pediatric surgeons associate with practice-readiness of a fellow: skill-based competency, the recognition and benefits of struggle, developing expertise and facilitating autonomy, and difficulties in variability of evaluation. While variability in evaluation is not typically included in the concept of practice readiness, assessment and evaluation were described by study participants as essential aspects of how practicing pediatric surgeons perceive practice readiness and competency in pediatric surgery fellows. Competency was further divided into interpersonal versus technical skills. Sub-themes within struggle included personal and professional struggle, benefits of struggle and how to identify and assist those who are struggling. Autonomy was commonly stated as variable based on the attending.

CONCLUSION

Our analysis yielded several themes associated with practice readiness of pediatric surgery fellows. We aim to further refine our list of themes using the Dreyfus Model as our interpretive framework and establish consensus amongst the community of pediatric surgeons in order to define competency and key elements that make a fellow practice-ready. Further work will then focus on establishing assessment metrics and educational interventions directed at achieving such key elements.

Competencies expected of undergraduate nursing students: A scoping review

AIM

Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work.

DATA SOURCES

We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar.

REVIEW METHODS

We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial.

RESULTS

Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development.

CONCLUSION

Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country.

IMPACT

These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

Appraising differential capabilities of new graduate nurses: Development across the first nine months of employment

BACKGROUND

Effective transition to practice for new graduate nurses (NGNs) is of national and international concern. Development of NGNs expands well beyond higher education studies and relies heavily on support during their first year of employment. Little is known of the differential development of NGNs, namely the trajectory of developing capability.

AIM

This study differentiates NGN development during their first year of employment through appraisal of universal domains of nursing practice relevant to the international community.

METHODS

Using a quantitative evaluation design NGN performance was appraised at 1-, 3-, and 9-months from February 2020 to November 2021, using a 23-item appraisal tool and accompanying behavioural cues organised around four universal domains of practice: professional values and behaviours; comprehensive nursing practice; organisational capabilities; personal growth and development; and a fifth domain specific to Australia, that is, legislative requirements. Workplace performance was appraised by clinical supervisors and numerically rated according to intensity of coaching required to meet requisite standards of practice.

RESULTS

The shift in rating scores of intensity of coaching required, over three time periods across four key universal domains, were statistically significant (p < .001). These findings which indicate the intensity of required coaching for maintenance of standards reduced over the time period suggest advancing NGN capability. The domain representing professional values consistently rated the highest. The domain denoting legislative requirements largely flattened after three months.

CONCLUSION

These findings corroborate the significant development of NGN capability during the first nine months of employment, especially during the initial three months. Furthermore, they provide empirical evidence that NGNs are most adept at demonstrating professional values; a recognised capability developed through employment during pre-registration studies. Discriminant data is of value to inform both targeted development of individual NGNs and when collated, the education needs of cohorts.

Cognitive and Noncognitive Factors Influencing Nursing Students' Academic Success: Structural Equation Model Analysis

AIM

The study aim was to identify and explore relationships among cognitive and noncognitive factors that may contribute to prelicensure baccalaureate nursing students' academic success across their program of study.

BACKGROUND

Nurse educators are challenged to improve students' academic success. With limited evidence, cognitive and noncognitive factors have been identified in the literature as potential factors that influence academic success and may support students' readiness for practice as new graduate nurses.

METHOD

Data sets from 1,937 BSN students at multiple campuses were analyzed using an exploratory design and structural equation modeling.

CONCLUSION

Six factors were conceptualized as contributing equally to the initial cognitive model. The final noncognitive model, with deletion of two factors, yielded the best fit for the four-factor model. Cognitive and noncognitive factors were not significantly correlated. This study provides a beginning understanding of cognitive and noncognitive factors associated with academic success that may support readiness for practice.

The assessment of undergraduate bachelor of nursing students in the collaborative clusters education model: A qualitative descriptive design

BACKGROUND

Worldwide, undergraduate Bachelor of Nursing students are required to complete experiential learning placements in health care settings as part of the curriculum. There are a variety of facilitation models that support student learning and assessment on clinical placement. As workforce pressures increase globally, innovative approaches to clinical facilitation are required. In the Collaborative Clusters Education Model of clinical facilitation, hospital-employed clinical facilitators work collaboratively within peer groups (clusters) to collectively participate in a process of facilitating student learning and conducting assessment and moderation of student performance. The assessment process in this collaborative clinical facilitation model is not well described.

AIM

To describe how the assessment of undergraduate nursing students is achieved in the Collaborative Clusters Education Model.

DESIGN

A qualitative descriptive approach was employed.

METHODS

In March 2021 individual and group interviews were conducted with seven clinical facilitators working in the Collaborative Clusters Education Model in one health service in southeast Queensland, Australia. Content analysis of transcribed interviews was performed.

RESULTS

Assessment was achieved through two processes, situational scoring and moderation. In the process of situational scoring, clinical facilitators balanced the students' perception of their role in assessment, accounted for the type of experiences available, considered multiple sources of evidence and used the Australian Nursing Standards Assessment Tool. In the process of moderation, clinical facilitators communicated with their cluster colleagues to determine a shared understanding of student history, considered data from multiple evidence sources and collaboratively evaluated the trustworthiness of student performance evaluation decisions.

CONCLUSIONS

In the Collaborative Clusters Education Model, the input of multiple assessors, working in a small team, ensured transparency in assessment processes. Furthermore, this transparency in assessment practices normalised on-going moderation, an in-built quality-check and, as such, an innovative component of assessment in the Collaborative Clusters Education Model. As nursing directors and managers seek to ameliorate the impact of nursing workforce pressures, this innovative model of collaborative assessment may serve as a valuable addition to nursing clinical assessment toolkits.

TWEETABLE ABSTRACT

The Collaborative Clusters Education Model of Clinical Facilitation enables transparency in assessment processes and normalises moderation.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs

Background

The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward.

Purpose

To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic.

Methods

We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data.

Results

The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19.

Conclusion

This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

Work Readiness of Newly Licensed RNs

OBJECTIVE

The aim of this study was to examine the work readiness of newly licensed RNs (NLRNs) based on demographics, education, and work experiences.

BACKGROUND

Work readiness is the extent to which new graduates possess qualities and competencies associated with workplace success. Work readiness of NLRNs complements their clinical knowledge and skills and has been shown to predict job satisfaction and work engagement.

METHODS

Two hundred ninety-seven NLRNs participating in the nurse residency program of a health system in the southeast region of the United States were surveyed using the Work Readiness Scale-Graduate Nurse.

RESULTS

Scores on all readiness dimensions were high. Analysis revealed unexpected differences in readiness dimensions based on race, nursing degree, and completion of a nurse externship program.

CONCLUSIONS

Work readiness adds to our understanding of factors that can affect the transition of NLRNs into the work setting. Further research is needed to understand how work readiness develops over time, factors that predict work readiness, and its relationship to NLRN retention and other outcomes.

The contribution of paid employment for students during their pre-registration nursing studies: An integrative review

OBJECTIVE

This integrative review of the literature explores potential associations between paid employment during students' pre-registration study period and development of workplace capabilities. The capacity to demonstrate attainment of standards of practice upon registration as a nurse is essential for the delivery of safe, quality care. The increasing shift, internationally, to higher education, concerns have been raised about limited time in practice settings and consequently nurses' capability upon employment. Extensive research has been conducted into student clinical placement models and graduates transition programs, but employment during students' pre-registration study has received little consideration.

DESIGN

An integrative approach of peer reviewed articles.

DATA SOURCES

A systematic search of the literature published between 1996 and 2021 across five electronic data bases; including Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline, American Psychological Association and Education Resource Information Centre was conducted.

REVIEW METHODS

Data was analysed according to the Whittemore and Knafl (2005) framework to maintain a methodical and meticulous approach.

RESULTS

Fourteen studies differentiated graduates employed during their studies. Employment contributed to developing capabilities across four domains, namely, personal growth and development, comprehensive nursing practice, organisational capability and professional values and behaviours upon employment.

CONCLUSION

Employment during pre-registration studies is associated with developing workplace capabilities. Opportunities to develop the capability of graduates should focus on the possibility of 'learning' during employment rather than merely a recruitment strategy.

Cardiac rehabilitation in rural and remote areas of North Queensland: How well are we doing?

OBJECTIVE

To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ.

SETTING

Four focus communities in R&R areas of NQ.

PARTICIPANTS

Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling).

DESIGN

A qualitative descriptive case study, with data collection via semi-structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities.

RESULTS

Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post-discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community-based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre-based CR services; lack of awareness, or acceptance of telephone support services.

CONCLUSION

To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in-service education, is required to developing a model of care that focuses on self-management and education: Heart: Road to Health.

Graduate Nurse Transition Programs Pivotal Point of Participants' Practice Readiness Questioned During the COVID-19 Pandemic Crisis: A Scoping Review

BACKGROUND

The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses' transition to become practice ready.

METHOD

A scoping review was conducted using the Joanna Briggs Institute scoping review framework.

RESULTS

Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses' clinical skills and confidence development. With nursing confidence and competence gained through professional practice experience, it is apparent that for a sustainable nursing workforce, greater access for graduating nurses to transition programs is imperative.

CONCLUSION

Recommendations include restructuring transition programs with possible time reductions, limited rotations, comprehensive orientations inclusive of preceptorship, and dedicated educators to increase and enhance supportive graduate nurse transitions. [J Contin Educ Nurs. 2021;52(8):392-396.].