Nurses' role transition from the clinical ward environment to the critical care environment

Reality shock in newly graduated critical care nurses and its association with missed nursing care: The mediating role of caring ability

OBJECTIVES

This study is a report assessing the intermediary role of caring ability in the association between reality shock in newly graduated nurses and missed nursing care.

RESEARCH METHODOLOGY/DESIGN

This descriptive study involved 286 newly graduated nurses working in various critical care units. Three standardized scales were used to collect data, including the Missed Nursing Care Scale, the Environmental Reality Shock-Related Issues and Concerns (ERS-RIC) Scale, and the Caring Ability Inventory (CAI). The Hayes' PROCESS macro in SPSS (Model 4) was utilized to perform mediation testing. The data was collected from March 2022 to July 2022.

SETTING

Critical care units in seven Philippine hospitals.

RESULTS

Newly graduated critical care nurses reported moderate levels of reality shock (mean = 50.31). Reality shock was directly associated with missed nursing care (β = 0.0493, p = 0.0066). Caring ability partially mediated the association between reality shock and missed nursing care through caring ability (β = 0.0042, SE = 0.0027).

CONCLUSIONS

Newly graduated critical care nurses experience reality shock during the initial two years of employment. Reality shock diminishes the caring abilities of the newly graduated nurses, leading to a higher incidence of missed nursing care.

IMPLICATIONS FOR CLINICAL PRACTICE

Institutional strategies aimed at facilitating a smooth transition for newly graduated nurses should be prioritized to prevent a decline in their caring abilities and ultimately reduce compromises in nursing care.

From registered nurse to nursing student - Exploring registered nurses' transition to nursing student during a post-registration children's nurse programme: A qualitative descriptive research study

BACKGROUND

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006.

OBJECTIVES

The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition.

DESIGN

A qualitative descriptive research design was used.

SETTING

The study was carried out in a large teaching children's hospital in Dublin, Ireland.

PARTICIPANTS

A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student.

METHODS

Face-to-face, semi-structured, conversation-style interviews were conducted.

RESULTS

Four main themes were identified from the data: 'Feelings related to returning to student status', 'Supports throughout the transition', 'Differences between disciplines' and 'Knowing your place'. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor.

CONCLUSIONS

The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship.

A narrative inquiry approach to understanding senior intensive care nurses' experiences of working with new graduate nurses

AIMS AND OBJECTIVES

To report a qualitative inquiry exploring senior registered nurses' stories of experience working with new graduate nurses in the intensive care unit.

BACKGROUND

While new graduate nurses' perceptions of transitioning into professional practice in the intensive care unit have been examined, few studies have explored the experiences of the senior registered nurses working alongside them.

DESIGN

A narrative inquiry methodology informed by Dewey's (1938) theory of experience.

METHODS

Individual in-depth, unstructured, interactive interviews were conducted with five senior registered nurses. The inquirer co-composed individual narrative accounts with each participant. Narrative inquiry's three commonplaces of temporality, sociality and place formed the lens of analysis. Thematic analysis identified two overarching threads that resonated across the narrative accounts. This inquiry adheres to COREQ checklist reporting.

RESULTS

The overarching threads 'Reverberations' and 'Caring' depict the experiences of senior registered nurses. 'It's Dangerous', 'Patrolling Like Surf Lifesavers', 'We Carry Them', 'Survival Mode' and 'Enjoyable Moments' are minor threads describing the challenges, while 'I've Been There', 'They Must Ask Questions' and 'Not In My Backyard' reveal their insights.

CONCLUSIONS

Working with new graduate nurses increased senior registered nurses' patient surveillance and workload, contributing to stress, pressure and feeling overwhelmed. However, senior registered nurses felt an obligation to care for new graduate nurses, who they perceived as still acquiring the skills to autonomously care for critically ill patients. Therefore, senior registered nurses require support themselves.

RELEVANCE TO CLINICAL PRACTICE

Senior registered nurses perceive workplace constraints as impeding their capacity to provide sufficient support and surveillance to new graduate nurses. The gap between new graduate nurses' clinical capacity and patients' needs underpins senior registered nurses' recommendation that new graduate nurses should not be placed in intensive care units unless additional workforce support is provided, safeguarding their development as well as patient safety.

Nurses' experiences on the road during transition into community care: An exploratory descriptive qualitative study in Singapore

Healthcare systems are evolving to meet the demands of an ageing population whereby the provision of health care services in the community has increased to alleviate the burden faced by acute care health facilities. As the result, the number of community nurses are expected to increase in order to meet the demand. Several studies have identified the unique challenges faced by the growing responsibilities of community nurses. However, fewer studies focused on the experiences of nurses transitioning to become community nurses as they rise to meet the unique challenges of working in the community. This study aimed to explore the experiences of nurses' transitions into community care while gaining insight into the transition process. The study adopted the exploratory qualitative approach. Data collection was performed through semi-structured interviews with 14 community nurses in Singapore. Interview sessions were digitally recorded and transcribed into verbatim, and the thematic analysis approach was used for data analysis. Three major themes and nine subthemes were developed from the data of 14 interviews. The three major themes are: 'Changes in Dynamics in a Nurse-Patient Relationship', 'To Live Up to Expectations', and 'Negotiating the Landscape in the Community'. New community nurses are experiencing stress and struggling to adapt with performing nursing care in uncontrolled environments. Additionally, higher expectations have been set on them even when they are still in transition. It is important to provide support for nurses, including in-service talks, courses and formal orientation programs. The study findings highlighted the importance of adequately preparing new community nurses and provided insights on developing a customised formal orientation program. This study also contributed to the limited body of knowledge with respect to nurses' transition experiences into community care.

Critical care nurses' experiences of providing care for adults in a highly technological environment: A qualitative evidence synthesis

AIMS AND OBJECTIVES

To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments.

METHODS

The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Appendix S1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, MEDLINE, EMBASE, PsycINFO, Campbell Collaboration, ProQuest A & I, DART and Lenus. Blind screening to select relevant studies was undertaken, and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework. Guided by Thomas and Harden's three-stage approach to thematic analysis, line-by-line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings was reviewed using GRADE-CERQual.

RESULTS

Twelve studies reported in thirteen papers, including 122 nurses, were selected in the final sample for synthesis. Three analytical themes were identified: (a) sometimes machines get all the attention, (b) with experience the patient becomes the focus and (c) technology can't save everybody.

CONCLUSIONS

Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person-centred care within the bounds of a technological environment.

RELEVANCE TO CLINICAL PRACTICE

The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.

The factors influencing the effective early career and rapid transition to a nursing specialty in differing contexts of practice: a modified Delphi consensus study

OBJECTIVES

This study aimed to test and further develop the 'Early Career and Rapid Transition to a Nursing Specialty' (TRANSPEC) model to a nursing specialty developed from a systematic review. Semi-structured interviews of specialist clinically based nurses and a consensus Delphi study with an expert panel were used to expand and achieve consensus, agreement, reliability and stability of the model.

DESIGN

A modified Delphi, two rounds (64 and 52 Likert items) of reiterative online questionnaires and one round as a nominal group technique, was informed by qualitative thematic analysis of semi-structured interviews.

SETTING AND PARTICIPANTS

Interviews with 14 specialists clinical practicing registered nurses and a panel of 25 national experts participated in the Delphi study.

RESULTS

The interview participants experienced 14 rapid transitions and three were early career transition. The overarching themes from the preliminary model were confirmed and further expanded. These were the self (personal and professional); the transition processes (final and informal); a sense of belonging; and the overarching context of practice over a time continuum. In the Delphi, the highest rating item was 'Specialty work colleagues respect, include, support, and accept specialist nurse on completion of transition processes'. Pre-entry was highlighted as an important time point prior to transition. All items reaching consensus were included in the final model. Cronbach α increased from 0.725 to 0.875 for the final model.

CONCLUSIONS

The TRANSPEC model is a valid and reliable evidence-based tool for use in the career pathway and development of nursing specialists. Using the Benner model 'Novice to Expert' after the novice incomer phase is achieved, further lifelong learning development will transform the novice specialist over time continuum.

Contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi

Background

There are no critical care nurse training programs in Malawi despite the high burden of diseases which culminate in critical illness. This paper presents contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi. The qualitative findings presented are part of a larger mixed methods study which explored learning needs of critical care nurses as a way of informing the development of a training program for the critical care nurses in Malawi.

Methods

Interpretive descriptive design was used. Data were gathered through 10 key informant interviews with nurse leaders (n=8) and anaesthetists (n=2); and two focus group discussions with registered nurses and nurse midwife technicians working in intensive care and adult high dependency units at two tertiary hospitals. Transcribed data were analyzed manually and through the use of NVivo data management software utilizing Thorne's steps of analysis1.

Results

Being unprepared to work in intensive care and high dependency units was a dominant theme. Factors that contributed to this sense of unpreparedness were lack of educational preparation, organisational factors and workforce issues. The consequences of nurses' perceptions of being unprepared were fearfulness, a change of nurses' attitudes and elevation of risk to patients. The nurses managed unpreparedness by relying on other health professionals and learning on the job.

Conclusion

The findings illuminated contextual issues to be considered when developing programs for upskilling nurses in hospitals within Malawi and contributes to the developing body of knowledge related to nursing education and practice development within developing countries.

From incomer to insider: The development of the TRANSPEC model - A systematic review of the factors influencing the effective rapid and early career TRANsition to a nursing SPECiality in differing contexts of practice

OBJECTIVE

Shortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice.

METHODS

A comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers.

RESULTS

Twenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse's transition is influenced by time.

CONCLUSIONS

For successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase.

Developing a community-based nursing and midwifery career pathway - A narrative systematic review

INTRODUCTION

Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported.

METHODS

This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice.

RESULTS

There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were 'the self' (professional and personal); 'transition processes'; and, a 'sense of belonging'. Sub themes included narrative identifying inhibitors and enablers in each theme.

DISCUSSION

No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.

The experiences of new graduate nurses hired and retained in adult intensive care units

BACKGROUND

It is a common practice that new graduate Registered Nurses are hired into adult intensive care units as initial entry into practise. There exists a practice readiness gap between nursing curricula and actual clinical practise expectations at adult intensive care settings; this has led to negative consequences and subsequent nurse turnover, a concern nationwide. Nonetheless, some new graduate nurses survived their initial transition and continue to practise in adult settings. The purpose of this study was to explore the experiences of nurses who were hired into adult intensive care as a new graduate and survived their transition from novice to competent, starting the third year of practise.

METHODOLOGY

The study used the hermeneutic phenomenology research approach.

FINDINGS

Data analysis revealed the overall meaning of the experience: coming to terms with being comfortable with being uncomfortable. The six themes associated with being comfortable with being uncomfortable were: confidence and uncertainty, gaining experiences and forever learning, intuitive knowing and intuition, difficult and stressful, being courageous and assertive, and the team and support people.

CONCLUSION

New graduate nurses can survive to become competent adult intensive care nurses. This study reveals the need to promote exposure to a variety of clinical situations early, to promote resilience and self-care, and to foster unit teamwork and mentoring to ensure successful transition and overall retention of new nurses hired into in adult intensive care.

Registered nurses transitioning from acute care to primary healthcare employment: A qualitative insight into nurses' experiences

AIMS AND OBJECTIVES

To describe the experiences of acute care registered nurses transitioning to primary healthcare settings.

BACKGROUND

The worldwide increasing demand for primary healthcare services has resulted in skilled acute care nurses transitioning to primary healthcare settings to meet workforce requirements. Little is known about the experiences and challenges associated with the transition. Knowledge of this will enable employers to design appropriate support processes and transitioning nurses can make informed choices.

METHODS

Semistructured interviews were conducted with nurses who had transitioned into primary healthcare employment in the last 5 years. Data analysis was undertaken using Braun and Clarke's (2006) thematic analysis approach.

RESULTS

Thirteen nurses were interviewed, and two themes identified-role learning: the new environment, and role socialisation: transition validation. Role learning was influenced according to the quality of orientation programmes, previous experience, clinical knowledge and professional support. Support and professional respect from mentors and/or employers greatly assisted with role socialisation and the transition experience.

CONCLUSIONS

Transitioning to primary healthcare employment provides unique challenges which must be considered by employers if they are to attract and retain experienced acute care registered nurses.

RELEVANCE TO CLINICAL PRACTICE

Understanding the experiences of nurses who transition from acute to primary healthcare employment can inform the design of orientation programmes and ongoing professional supports to address barriers and challenges. Targeted orientation and support has the potential to enhance recruitment and retention of experienced nurses in primary health care.

Becoming an Air Force Nurse: The Experience of Transition A New Perspective of a Known Phenomenon

PROBLEM

Transitions in nursing have consistently been described as complex and stressful. While the literature is replete with studies investigating role transitions in civilian healthcare settings, there is no known research that explores the role transition of experienced nurses who move from civilian to military nursing practice. Using nurses in the U.S. Air Force as an exemplar, this study serves as a starting point to understand the transition process and challenges likely encountered by nurses new to the military. The outcomes of this study could influence future efforts to recruit and retain qualified nurses.

METHODS

A hermeneutic, phenomenologic approach was used to explore and describe the lived experience of transition from civilian staff nurse to Air Force staff nurse.

FINDINGS

The results indicated that new Air Force nurses encounter challenges related to a lack of knowledge and role preparedness, which led to feelings of stress and frustration. Support from peers, mentors, and managers helped the new Air Force nurses bridge the gap in knowledge and successfully integrate into the military culture.

IMPLICATIONS

Efforts to reduce the perceived lack of knowledge through improvements to the Commissioned Officer Training program and the clinical orientation period are recommended.

Experiences of registered nurses transitioning from employment in acute care to primary health care-quantitative findings from a mixed-methods study

AIMS AND OBJECTIVES

To describe the experiences of registered nurses who transition from acute to primary health care (PHC) employment.

BACKGROUND

Internationally the provision of health care in PHC settings is increasing. Nurses are moving from acute care employment to meet the growing demand for a PHC workforce. However, little is known about the transition experiences of these nurses.

DESIGN

A sequential mixed-methods study comprising a survey, and semi-structured interviews. This study reports on survey findings relating to the transition experience.

METHODS

Convenience and snowballing techniques were used to recruit 111 registered nurses who had transitioned from Australian acute settings to PHC employment within the last 5 years. An online survey gathered data relating to personal and professional demographics, type of PHC setting and transition experiences.

RESULTS

Most respondents (n = 90, 81.1%) reported receiving some orientation, although the length and content varied considerably. Those working in metropolitan locations were more likely to report concerns associated with their orientation, with respondents from rural or remote locations more likely to have access to a preceptor than city/metropolitan respondents. Just under half of respondents found prioritising workload (n = 47; 42.7%) or organisational knowledge (n = 45; 40.9%) difficult or very difficult, and 47.7% (n = 53) felt isolated or unsupported. 49.5% (n = 55) reported being overwhelmed with the new role either sometimes or regularly. Barriers to transitioning successfully included limited employer support to attend professional development activities.

CONCLUSIONS

Availability of specific support measures may assist in the transition process. Findings from our study should be considered by employers when recruiting nurses new to PHC, and when designing orientation and ongoing education programmes.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the challenges faced by nurses who transition from acute care into PHC employment. Understanding the barriers and facilitators to successful transitions enhances the process for future recruitment and retention of PHC nurses. This evidence can inform managers, educators and policymakers in developing support programmes for nurses moving into PHC.

Competence of nurses in the intensive cardiac care unit

INTRODUCTION

Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses' competences. This study aimed to explain nurses' competence in the ICCU.

METHODS

This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012-2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method.

RESULTS

The main categories were "clinical competence," comprising subcategories of 'routine care,' 'emergency care,' 'care according to patients' needs,' 'care of non-coronary patients', as well as "professional competence," comprising 'personal development,' 'teamwork,' 'professional ethics,' and 'efficacy of nursing education.'

CONCLUSION

The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing.