Newly qualified nurses' transition from learning to doing: A scoping review

Program components, impact, and duration of implementing a new nurse orientation program in hospital contexts: A scoping review

Background

Orientation programs for new nurses play an essential role in preparing them for challenges in clinical practice. Different countries have applied varying program components and durations in organizing these programs.

Objectives

To explore the program components, impact, and duration of the orientation programs for new graduate nurses in hospital care settings.

Method

We gathered information from studies conducted in various countries. Searches were conducted on databases including PubMed, Sage Journal, ScienceDirect, EBSCO, and Wiley, with secondary searches from 2018 to 2023 using Arkey and O'Malley's Review Scoping Framework. The inclusion criteria comprised studies with primary data, both qualitative and quantitative, focusing on new nurses undergoing orientation programs in hospitals.

Results

Of the 989 articles screened, 14 were included. Methods identified included providing hands-on experience, sharing information, reflecting on work experiences, and developing technical skills. Significant findings encompassed increased competence, knowledge, confidence, and satisfaction, as well as professional development and positive organizational impacts. The duration of orientation programs ranged from 2 weeks to 2 years, depending on the program type and new graduate nurse needs.

Conclusion

This scoping review elucidates program components, impact, and duration of new nurse orientation programs in hospitals, providing valuable insights for hospital management in designing and developing improved programs.

Tweetable abstract

Exploring program components, impact, and duration of hopitals new graduate nurse orientation programs, revealing insights to enhance patient care and nursing practice@Ns_Ernawaty.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Examining how early experiences in oncology settings influence nurses' career decisions

The transition from nursing student to newly registered nurse is a complex process, and subsequent recruitment to cancer nursing posts can be challenging. This article details a service evaluation that aimed to describe the experiences of nursing students on placement and newly registered nurses or nursing associates working in a specialist cancer centre, and how these experiences might influence their future career aspirations. To gather data, the authors undertook a focus group with nursing students ( n= 8) and interviewed newly registered nurses or nursing associates ( n= 19). The data revealed four themes: navigating the nursing student experience; motivation to work in oncology; transition to staff nurse; and looking ahead. The service evaluation identified that education providers often lack awareness of cancer-specific content and career pathways. It also found that some aspects of cancer care, such as gaining specialist skills in systemic anticancer therapy, require particular attention since they were often anxiety-provoking for newly registered nurses.

A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy

BACKGROUND

The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US).

METHODS

A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting.

RESULTS

A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity.

IMPLICATIONS

Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

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.

Exploring registered nurses' perspectives as mentors for newly qualified nurses: a qualitative interview study

OBJECTIVE

Existing research has focused mostly on mentees' experiences of mentoring rather than mentors' experiences. Therefore, this study describes registered nurses' experiences of being a mentor for newly qualified nurses.

DESIGN

A qualitative interview study based on semistructured individual interviews. Interviews were analysed using qualitative content analysis.

PARTICIPANTS AND SETTING

A purposive sample of experienced registered nurses (n=21) from healthcare units in northern Sweden and northern Norway. Inclusion criteria were to have been a mentor to at least one newly qualified nurse, hold permanent employment of 75%-100% as a registered nurse and to be able to communicate in Swedish or Norwegian.

RESULTS

Our study's findings suggest that being a mentor plays a crucial role in establishing safety in complex work environments. The main theme consists of three themes: feeling motivated in being a mentor; continuously developing the learning environment; and navigating obstacles and cultivating support.

CONCLUSION

Being a mentor is a complicated role for registered nurses. The mentoring role is beneficial-ie, positive and rewarding-if facilitated sufficiently in the context of a structured organisation. This study brings a more profound understanding of and provides new insights into registered nurses' perspectives and needs regarding being a mentor and the study's findings make an important contribution to the field of nursing regarding the facilitation of mentoring.

Understanding the mechanism of safety attitude mitigates the turnover intention novice nurses via the person-centred method: A theory-driven, deductive cross-sectional study

AIM

Examine profiles of safety attitudes among novices and explore whether profiles moderate the occupational identity-turnover pathway.

BACKGROUND

Novice nurses face unique challenges in adopting positive safety attitudes, which influence outcomes like turnover. However, past research found only average levels of safety attitudes among novices, ignoring possible heterogeneity. Exploring whether meaningful subgroups exist based on safety perspectives and factors shaping them can provide insights to improve safety attitudes and retention.

DESIGN

This study was designed as a cross-sectional investigation.

METHODS

Data were collected through the distribution of questionnaires. Descriptive statistics were first conducted, followed by latent profile analysis. We then carried out univariate analysis and ordinal multinomial regression to explore the factors shaping the different profiles. Finally, we examine the moderating effect of nurses' safety attitudes with different latent profiles on the relationship between professional identification and turnover intention.

RESULTS

A total of 816 novice nurses were included. Three profiles were identified: high, moderate and low safety attitudes - higher attitudes were associated with lower turnover intention. Interest in nursing, health status, identity and turnover predicted profile membership. Moderate profile had a stronger buffering effect on the identity-turnover link versus high profile.

CONCLUSION

Multiple safety attitude profiles exist among novice nurses. Certain factors like interest in nursing and occupational identity are associated with more positive safety profiles. Targeting these factors could potentially improve safety attitudes and reduce turnover among novice nurses. The moderating effects suggest that tailored interventions matching specific subgroups may maximize impact.

IMPACT

Assessing subgroup attitudes enables tailored training for novices' specific needs, nurturing continuous improvement. Supporting early career development and role identity may strengthen retention intentions.

[The bibliography group, between dream and reality in nursing practice]

The shock of reality that nursing students face when they start out will affect the nursing profession even more in the future, as it faces a recruitment crisis in the midst of renewal. Restoring meaning to the nursing profession is a complex and daunting challenge. By providing access to scientific literature, the bibliography group can contribute to this, based on an Evidence-Based Nursing approach. This initiative, which is beneficial for professionals whose skills development is thus encouraged, is designed to be simple and accessible to as many people as possible.

Renewing the Nursing Culture: Sustaining the Professional Community of Practice Through the Role of the Preceptor

Culture is the driving frame within which all human action takes form. This article explores the elements and characteristics of culture and applies them to the nursing professional community of practice. As it drills down to the work in the cultural context, it argues for the central role of the preceptor in evidencing the influence of culture. For onboarding nurses and the nursing community, the preceptor becomes the carrier of culture, demonstrating the impact of culture in a way that exhibits its influence and impact on nursing practice and patient care.

Program coordinators' perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study

PURPOSE

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators' perspectives on implementing a transition program for newly graduated nurses.

DESIGN/METHODOLOGY/APPROACH

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

FINDINGS

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

ORIGINALITY/VALUE

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

Comparison of the Effectiveness of Single-Loop and Double-Loop Debriefing Techniques

BACKGROUND

The goal of this study is to compare the quality between single-loop and double-loop debriefing techniques from the perspectives of new nurses, preceptors, and senior nurses. Single-loop debriefing techniques were used in traditional nursing education. In recent years, double-loop debriefing techniques have been used in nursing education.

METHOD

This study adopted a prospective observational design, and the sample included three groups, new nurses, preceptors, and senior nurses, each with 53 participants. The Debriefing Assessment for Simulation in Healthcare (DASH) instrument was used to measure the quality of different debriefing techniques.

RESULTS

The DASH scores for double-loop debriefing techniques were significantly higher than the scores for single-loop debriefing techniques among the three groups. The scores for new nurses were higher than those for the senior nurses and preceptors.

CONCLUSION

The results indicated that double-loop debriefing techniques are more effective than single-loop debriefing techniques. Double-loop debriefing techniques can improve teaching satisfaction. [J Contin Educ Nurs. 2024;55(3):137-143.].

Being a Newly Qualified Nurse: A Nordic Focus Group Study

Introduction

The transition to working life as a newly qualified nurse (NQN) can be challenging, leading to heightened stress levels. While NQNs are generally enthusiastic about starting their careers, they often express concerns about various responsibilities and a perceived lack of experience in independently dealing with clinical care in complex environments.

Objective

To acquire an in-depth understanding, from a caring science perspective, of what it means to be an NQN during the transition period of the first 18 months in the profession.

Methods

This study relied on an exploratory qualitative design. The methodological approach followed Gadamer's hermeneutic philosophy. Six focus group interviews were conducted in northern Norway (n = 3) and northern Sweden (n = 3) from January through May 2021. The interpretation of the data was inspired by Fleming et al. Nineteen female and seven male NQNs working in different contexts, including hospitals and municipalities, participated in the study. The consolidated criteria for qualitative research were used to report the results.

Results

Perspectives on NQNs are presented as three themes: a) the responsibility was perceived as a significant challenge, b) being a nurse is complex and demanding, and c) a desire for personal and professional development. Learning to be a nurse shouldering responsibility necessitates support and guidance from caring and compassionate colleagues and leaders.

Conclusions

This study sheds light on the importance of creating a workplace culture where NQNs' learning is promoted and supported by designated mentors during their transition to working life. The responsibilities should be aligned with their level of knowledge. It is important that leaders hold developmental dialogues and ensure a career plan for NQNs to continuously develop their knowledge and skills. Intervention studies designed to evaluate the meaning of the support from appointed mentors within structured mentorship programs are needed.

Exploring the gap between school of nursing theoretical foundations and clinical practice

BACKGROUND

Theoretical and practical preparation is essential for developing competent nurses. The clinical setting is the most effective context for learning nursing skills. It gives opportunities for newly qualified nurses to practice clinical decision-making by applying theoretical knowledge. Integrating theory and clinical practice with good supervision improves newly qualified nurses' competencies to care for patients and enhance their self-confidence.

OBJECTIVE

To identify the gaps between theoretical preparation in the schools of nursing and actual hospital clinical work in a public hospital in Bahrain and to suggest possible solutions to overcome these gaps.

METHODS

A qualitative descriptive study design was used in a tertiary public hospital in Bahrain. Ten newly employed registered nurses were recruited using purposive sampling. Semi-structured interviews were conducted, and a thematic analysis was employed.

RESULTS

Two Over-arching themes emerged from the analysis of the responses. The first identified the causes of the gaps that new nurses face in the transition (Lack of autonomy, technology employed in healthcare settings, impact of the COVID-19 pandemic, and lack of clinical exposure). The second provided possible solutions for these gaps (Open communication and collaboration, orientation phase and preceptorship, empowerment and self-confidence, and more clinical exposure).

CONCLUSIONS

Good collaboration between schools of nursing and healthcare care organizations can incorporate suggested solutions given by the study participants to reduce the identified gaps.

An Individualized, Holistic Approach to Supporting New Graduate Nurses

New graduate nurses bring unique strengths and opportunities for growth to transition to practice. This article describes strategies organizations can use to foster an individualized and holistic approach to clinical competency and well-being development. [J Contin Educ Nurs. 2023;54(11):492-494.].

Newly graduated nurses use and further development of assessment skills-An in-depth qualitative study

AIMS

To explore in-depth nurses' use and further development of assessment skills in different nursing contexts in the first 2 years after graduation, and factors that influenced their use and development of assessment skills.

DESIGN

The study had explorative qualitative design.

METHODS

Eight nurses who previously had been interviewed about their learning of physical assessment skills in clinical rotation as students participated in this follow-up study. Individual in-depth interviews were conducted, where the nurses spoke freely about their experiences after graduation.

RESULTS

Four prominent features influencing the nurses' use and development of assessment skills were identified: (a) assessment approaches and readiness for practice, (b) the primacy of communication, (c) recognition related to performing assessments, and (d) the influence of organizational factors on their assessment applications.

CONCLUSION

Newly graduated nurses' use of assessment skills is an important part of providing holistic care. This study suggest that assessment skills is not only an assessment task but is central in relationship building and in supporting the professional development of nursing competence.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution, due to study design.

A Statewide Nurse Residency Program Evaluation

Across the nation, hospitals are answering the call to action for funding and requiring new-to-practice registered nurses to complete a nurse residency program (NRP). In response, all Maryland acute care hospitals successfully funded, adopted, and implemented a 12-month standardized, commercially available (vendored) NRP. However, although the hospitals use the same curriculum, their administrative practices, content, and deliverables vary. A statewide program evaluation was conducted by the Maryland Organization of Nurse Leaders, Inc./Maryland Nurse Residency Collaborative to understand the NRP structure and process variability, including implementation challenges, and what worked and what did not. Findings from 26 semi-structured interviews with Maryland acute care hospital NRP coordinators showed that leadership support and resources, differences in patient populations, number of nurse residents, and organizational requirements best explained programmatic adaptations. Using lessons learned, best practices are shared, including methods to garner leadership support and reduce adaptations. Although program customization is expected, program replicability and scalability are essential to achieving program outcomes. [J Contin Educ Nurs. 2023;54(9):421-429.].

Transition to professional practice: Perspectives of new nursing graduates of Nepal

BACKGROUND

Internationally, the transition from student nurse to practicing nurse is recognized as being the most stressful period. Yet very little is known about how new nursing graduates perceive this transition in Nepal. The study aimed to explore new nursing graduates' perceptions of the transition to professional practice.

METHODS

A qualitative descriptive methodology was used. In-depth semi-structured interviews were conducted with 10 purposively recruited participants from two private hospitals in Nepal. Data were analyzed using inductive thematic analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to report the findings of this study.

RESULTS

New nursing graduates perceived the transition to professional practice as an intense experience. Inductive thematic analysis yielded four intrinsically linked themes that encompassed new nursing graduates' transition experiences: 'getting hit by reality', 'losing confidence', 'feeling unsupported', and 'gathering strengths.' The theme 'getting hit by reality' included three sub-themes: 'gap between theory and practice,' 'no protective shield,' and 'plethora of responsibilities', which explains nurses' initial encounter with real-world practice. The theme 'losing confidence' contained three sub-themes: 'being fearful,' 'being ignored,' and 'being accused,' which describes how nurses started losing confidence as they confronted the real side of the profession. The theme 'feeling unsupported' included two sub-themes: 'left without guidance,' and 'limited support from seniors,' which explains how nurses perceived their work environment. The theme 'gathering strength' contained two sub-themes: 'reflecting' and 'asking for help,' which describes how nurses coped with the challenges related to the transition.

CONCLUSION

To facilitate the transition to practice, educational institutions must impart to students a realistic understanding of the transition process, address the theory-practice gap, and collaborate with hospitals. Similarly, hospitals should have realistic expectations from new nurses, assign work according to their capabilities, and allow them sufficient time for role integration. Likewise, well-conceived detailed orientation, mentorship or preceptorship programs, and regular professional development programs are vital to easing the transition. Furthermore, establishing and maintaining a supportive work culture, which promotes equity, respect, and safety among employees, is crucial for positive transition experiences.

Assessing the psychometric properties of the Arabic version of the Nursing Practice Readiness Scale among Saudi nursing students

Readiness to practice nursing is essential for nursing students to ensure that they are conscientious, have a sense of responsibility, and are rational in performing their clinical practice. This study tested the psychometric properties of the "Nursing Practice Readiness Scale" Arabic version (NPRS-A) to assess Saudi nursing students' readiness to practice nursing in clinical settings. This study used a methodological design to examine the psychometric properties of the NPRS-A among 373 nursing students in Saudi Arabia. The findings provide evidence of the NPRS-A's good content validity. The PCA revealed five distinct components with a "cumulative variance explained" of 69.2%. The test of difference on the nursing practice preparedness between students from different levels showed that students in the 2nd year were less prepared than junior and senior nursing students. The correlation test showed that a higher GPA and higher self-reported readiness are more ready to practice nursing in clinical settings. The research showed an overall Cronbach's alpha of 0.957. The establishment of the NPRS-A is significant, not only in Saudi Arabia but other Arabic-speaking countries. Nurse educators and nursing education policymakers can use this version to assess nursing students' learning needs to be prepared to practice nursing.

Effect of Repeated Multipatient Simulations on Professional Readiness Among Senior Nursing Students

BACKGROUND

Senior nursing students are expected to be ready in terms of professional decisions and practices as soon as possible after graduation. Quality and Safety Education for Nurses (QSEN) is a framework to prepare nursing students for practice in the health care system.

PURPOSE

This study aimed to explore the effect of repeated exposure to multipatient simulations on senior nursing students' pregraduation transition views, QSEN knowledge level and self-competency, professional readiness, and postgraduation transition shock.

METHODS

A randomized controlled trial of intervention and control groups with pretest, posttest, and a follow-up was conducted with 78 senior nursing students at a private, accredited, nursing program in Istanbul, Turkey.

RESULTS

There was a statistically significant improvement in the intervention group between the pretest and the posttest for self-confidence ( P < .01), QSEN knowledge level ( P < .01), and professional readiness ( P < .01). The QSEN knowledge level ( P < .01) and professional competency ( P < .05) of the intervention group were higher than those of the control group.

CONCLUSION

These results suggest that multipatient simulations may be an effective strategy to better prepare students for the health care system's demands.

How do new midwives' early workforce experiences influence their career plans? An integrative review of the literature

AIM

To explore how the early workforce experiences of new midwives influence their career plans.

BACKGROUND

Each year, thousands of new midwives graduate from entry-to-practice midwifery courses, gain professional registration, and enter the workforce. Despite this, the world continues to face a shortage of midwives. The first five years of clinical practice, commonly referred to as the early career period, can be highly stressful for new midwives, contributing to early attrition from the profession. Supporting the transition from midwifery student to registered midwife is vital if we are to grow the workforce. Whilst the early career experiences of new midwives have been more broadly explored; little is currently understood about how these can influence their career plans.

METHODS

Following Whittemore and Knafl's (2005) five-stage process, an integrative review was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the criteria for inclusion. Thematic analysis was undertaken to organise and present the findings.

FINDINGS

Thematic analysis, guided by the review question led to the identification of three overarching themes: 'the need for support', 'sustaining health and wellbeing', and 'being able to provide safe and effective midwifery care'.

CONCLUSION

Very little research to date has specifically explored how the early career experiences of new midwives influence their career plans, particularly within the Australian context. Further research is required to better understand how the early workforce experiences of new midwives can either strengthen their commitment to the profession or contribute to the decision to leave midwifery prematurely. This knowledge would provide a basis for the development of appropriate strategies to minimise early attrition from the midwifery profession and promote career longevity.

Newly qualified registered nurses' and midwives' experiences from rural health district placement in Namibia

BACKGROUND

The transition period for newly qualified registered nurses/midwives (NQRN/Ms) is a fundamental phase in their career. Yet, transition experiences have been studied mostly within urban and/or specialised healthcare settings in high-resource countries. This study aimed to explore and describe the experiences of NQRN/Ms in a rural health district in Namibia.

METHODS

A qualitative, descriptive, explorative, and contextual design was followed. The sample consisted of eight participants who were purposively selected. Data were collected via in-depth individual interviews and analysed following a reflexive thematic analysis. The researchers were guided by Lincoln and Guba's strategies for establishing trustworthiness.

FINDINGS

Themes conceptualised from the analysis include encounters with rural community members; encounters with colleagues; staffing, management, and supervision; shortage of resources; poor infrastructure; unreliable communication networks; and the lack of social life.

CONCLUSION

The NQRN/Ms had mixed experiences related to a variety of aspects such as social life, resources, colleagues and community members. These findings can be used to improve undergraduate nursing curricula, as well as to create graduate job preparation workshops and support networks.

Associations Between the COVID-19 Pandemic and New Nurses' Transition to Practice Outcomes: A Multi-site, Longitudinal Study

Background

The transition between nursing school and nursing practice has been well studied and recognized as a turbulent time for new nurses. Existing literature suggests that transition to practice (TTP) programs can successfully support new nurses through this challenging period. However, TTP program outcomes have not been studied related to the COVID-19 pandemic, which altered TTP experiences for many new nurses by limiting their access to clinical sites for hands-on patient care experience and shifting delivery of nursing education and TTP programs from in-person to virtual environments.

Purpose

The purpose of this study was to analyze the associations between TTP outcomes and the COVID-19 pandemic.

Methods

This was a retrospective correlational, longitudinal study using secondary analysis of Vizient /AACN Nurse Residency Program survey data from the Casey-Fink Graduate Nurse Experience Survey and the Nurse Resident Progression Survey. Self-reported data from new nurses in Southeast Texas who participated in a standardized TTP program before the COVID-19 pandemic (2017-2019) were compared with self-reported data from nurses who participated in the TTP program during the pandemic (2020 and 2021).

Results

A total of 2,673 nurses participated in this study. When adjusting for demographic composition of the cohorts, statistically significant differences (p < .05) were identified in the advocacy, patient safety, and commitment outcomes with a decline in change scores from baseline to 12 months in the COVID-19 pandemic cohort compared to the pre-COVID-19 pandemic cohort.

Conclusion

Our findings provide new information on the impact of the COVID-19 pandemic on new nurses' participating in a standardized TTP program. The results indicate that patient safety and commitment to staying employed in the organization and the nursing profession should be priority improvement areas for employers and TTP program staff as they work to support new nurses' TTP in a pandemic.

Relationship between Transition Shock, Professional Stressors, and Intent to Leave the Nursing Profession during the COVID-19 Pandemic

Background and Objectives: Moving nurses to a COVID-19 department may cause the phenomenon of transition shock, which occurs when already employed nurses change jobs. A set of confusing and uncertain feelings arise due to the unfamiliar work environment, which may lead to their intention to leave the nursing profession. The aim of this study was to examine transition shock and the contribution of both the respondents’ characteristics and the presence of stressors to the occurrence of transition shock in nurses assigned to work in COVID-19 departments. Materials and Methods: A cross-sectional study with 120 nurses employed in COVID-19 departments was conducted. Several linear regression models were used to assess the association between transition shock, personal and professional COVID-19 stressors, and the intention to leave the nursing profession. Results: Nurses who intended to leave the profession showed higher transition shock and higher personal and professional stressors (p < 0.001). Female nurses had lower transition shock (β = −0.16; p = 0.036) and higher personal COVID-19 stressors (β = 0.27; p < 0.001). University education contributes to the lowering of nurses’ transition shock (β = −0.16; p = 0.038). Nurses who did not intend to leave the nursing profession had lower personal COVID-19 stressors (β = −0.15; p = 0.044). Transition shock was associated with personal COVID-19 stressors (β = 0.39; p < 0.001) and professional COVID-19 stressors (β = 0.29; p < 0.001), and vice versa. Conclusions: The phenomenon of transition shock was present after nurses transitioned to working in COVID-19 departments. Transition shock may cause more nurses to leave the profession, which may have a strong impact on the health system in many countries that are already facing a shortage of nurses. Additional education on and preparation for adapting to new working conditions with psychological support could have an influence by lowering the level of nurses’ transition shock.

Transition Into Practice: Outcomes of a Nurse Residency Program

Background Nurse residency programs (NRPs) have been proposed to meet the educational needs of new graduate nurses and facilitate the transition into practice. Although most studies indicate the benefits of NRPs to assist nurses during transition into practice, only one study compared an NRP with a control group. This study examined whether nurses in an NRP transitioned into practice more successfully than nurses in a traditional orientation program. Method This study enrolled 106 newly employed graduate nurses into study arms by unit: a nurse residency intervention group or a control group of standard nursing orientation. Casey-Fink Readiness for Practice, Nurse Retention, and Nurse Job Satisfaction surveys measured group outcomes. Results Readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed marked improvement. Conclusion The NRP resulted in improved readiness for practice, improved nurse retention, and higher job satisfaction compared with standard orientation. [J Contin Educ Nurs. 2023;54(1):32-39.].

New Graduate Nurses' Experiences and Challenges during a One-Year Clinical Rotation Programme in the Volta Region of Ghana: Implications for Nursing Management and Nursing Workforce Retention

Background

To help improve the standards and quality of nursing practice, newly graduated nurses and midwives are required after passing the Nursing and Midwifery Council's Licensing Examination to undertake a one-year mandatory clinical rotation at health facilities before registration. However, there is a lack of scientific studies to explore new graduate nurses' experiences and challenges during the one-year mandatory clinical rotation programme.

Aim

This study is aimed at exploring newly qualified nurses' experiences and challenges during the one-year mandatory clinical rotation in health facilities in the Volta Region of Ghana.

Methods

This qualitative exploratory study used a combination of focus group discussions (FGDs) and individual interviews. Thirty (30) newly qualified nurses were selected from two secondary and one tertiary health facilities, where newly qualified nurses are posted for a clinical rotation programmes to participate in the study. A total of two focus group discussions (FGDs) were conducted, comprising five (5) members in each group. Moreover, twenty (20) newly qualified nurses were interviewed individually, and their data were added to what was obtained from the focus group discussions. This study adopted the thematic analysis approach to analyze the data.

Results

The results of this study showed that newly qualified nurses experienced the following during the one-year clinical rotation programme: acquisition of more knowledge and competencies to assume professional nursing roles; lack of knowledge of the objectives of the clinical rotation programme by hospital staff; experience of frustration during the clinical rotation programme; inadequate supervision and support; accommodation and financial challenges.

Conclusion

The study revealed important challenges experienced by new graduate nurses during the clinical rotation programme, including hospital staff's lack of knowledge regarding the objectives of the rotation programme, inadequate supervision and support, and accommodation and financial challenges. There is a need for the Nursing and Midwifery Council to develop guidelines for the one-year mandatory clinical rotation for newly graduated nurses and midwives to make the programme more effective.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

"Jumping into the COVID-19 arena": The professional transition into clinical practice of new graduate nurses in Italy at time of COVID-19

AIMS AND OBJECTIVES

To evaluate the impact of the professional transition of new graduate nurses during the COVID-19 pandemic.

BACKGROUND

The transition from the role of student to the professional role can be challenging for new graduate nurses for the acquisition of higher autonomy and responsibility. The COVID-19 pandemic impacted the quality of the professional transition.

DESIGN

This was a cross-sectional observational study following the Strengthening and Reporting of Observational Studies in Epidemiology checklist.

METHODS

One hundred and two nurses who graduated in three consecutive sessions (November 2019-pre-pandemic, March 2020-pandemic outbreak, and November 2020-2nd wave) in a north Italian university located in the most affected Italian region by the COVID-19 pandemic, completed an online survey assessing well-being, risk of burnout, resilience, perceived stigma, strengths and limitations and quality of the professional transition. The study was performed between March and May 2021.

RESULTS

81.4% of participants described the professional transition as worse than expected, and new graduate nurses who worked in COVID-19 settings reported a more difficult transition to professional life. No differences emerged in burnout, mental well-being and perceived stigma between new graduate nurses who worked in COVID-19 settings and those who did not. Similarly, no differences emerged amongst the three graduated cohort sessions. The most commonly mentioned challenges faced during the transition were organisational aspects, suddenly acquired autonomy and lack of suitable coaching.

CONCLUSION

New graduate nurses reported a challenging academic-professional transition, in particular, those who worked in COVID-19 settings. The mid- and long-term impact of experiencing an academic-professional transition in COVID-19 settings should be assessed and monitored.

RELEVANCE TO CLINICAL PRACTICE

The professional transition of new graduate students should be adequately planned and monitored, new graduates should be assisted to develop realistic expectations about the transition, and an adequate coaching period should be guaranteed all the more during health emergencies.

Ability to Care in Acute Situations-The Influence of Simulation-Based Education on New Graduate Nurses

INTRODUCTION

Simulation-based education is frequently used in transition programs for new graduate nurses. Simulation-based education is implemented as a measure to practice nursing skills, gain experience, and prepare nurses for caring in challenging situations, such as acute situations. However, concerns about the data supporting the use of simulation are obtained from small studies that do not use validated measurement scales.

OBJECTIVE

This study aimed to explore the influence of simulation-based education on new graduate nurses' perceived ability to provide care in acute situations.

METHODS

A total of 102 new graduate nurses participated in simulation-based education as a mandatory part of an introductory program. They completed a premeasurement and a postmeasurement using the Perception to Care in Acute Situations scale. The Wilcoxon signed-rank test and the paired samples t test were used to test the statistical significance of outcomes for the simulation-based education, with the alpha set at 0.05. Cohen's d formula was used to calculate the effect size.

RESULTS

The Wilcoxon signed-rank test on the total scale score showed that simulation-based education resulted in a statistically significant change in the nurses' perceptions of their ability to care in acute situations (N = 99; Z = 7877; P < .001). The paired samples t test showed that the mean posteducation score was significantly higher (P < .001) in the total score. Cohen's d formula (-1.24) indicated a large effect size on the total score.

CONCLUSION

Simulation-based education can provide an effective means of improving new graduate nurses' perceived ability to provide care in acute situations.

Influence of Sleep Characteristic Changes on Nurses' Quality of Life during Their Transition to Practice: A Prospective Cohort Study

Aim: To explore the effect of changes in sleep characteristics on changes in quality of life during the transition period of new graduate nurses. Background: Sleep problems among nurses are associated with negative physical and psychological consequences. Methods: This prospective cohort study was conducted at a tertiary hospital in South Korea. Participants included 88 newly graduated nurses. Data were collected twice, prior to shift work and after 4 months of working as a nurse, via online structured self-report questionnaires created using Survey Monkey from March 2018 to February 2020. A generalized linear mixed model was used to analyze the influence of changes in sleep characteristics on quality of life. Results: A generalized linear mixed model showed that changes in the subjective quality of sleep, subjective health perception, and daytime dysfunction influenced quality of life changes during the transition. This implies that deterioration already existed. From their undergraduate period to four months after they began working as nurses, a significant decrease was observed in the quality of sleep. Participants’ quality of life significantly decreased. Conclusions: Changes in the quality of life of new graduate nurses may show deterioration with a significant drop in subjective sleep quality. Institutions should improve existing work adaptation programs provided during new graduate nurses’ transition to practice by including information on changes in nurses’ health caused by changes in sleep characteristics and sleep quality.

Exploring core competencies of clinical nurse preceptors: A nominal group technique study

AIM

The aim of this study was to explore core competencies of nurse preceptors based on the perspectives of postgraduate-year nurses, nurse preceptors and head nurses.

BACKGROUND

Perspectives of core competencies of nurse preceptors are varied among postgraduate-year nurses, nurse preceptors and head nurses, which makes it difficult to establish preceptor training programs and develop evaluation instruments.

DESIGN

A nominal group technique study.

METHODS

A nominal group technique procedure was applied to small-group and large-group discussion. The participants were recruited from the inpatient units at five nonprofit hospitals, each having over 1000 patient beds, in Taiwan. A total of 101 participants were involved in this study: 32 postgraduate-year nurses, 42 nurse preceptors and 27 head nurses, who were respectively sorted into five, six and four small groups with six to eight members in each group. After applying nominal group technique procedure, the core competencies were scored and ranked. Based on the final scores and ranking, the core competencies that the participants felt to be most important for nurse preceptors were identified. The expert panel then integrated these core competencies and derived a consensus.

RESULTS

Seven core competencies of nurse preceptors were derived, in order of declining importance: teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency, critical thinking and reflection and consultation on academic writing. All participants perceived that teaching traits (198 points) and clinical nursing profession (161 points) were the most important. Consultation of academic writing is unique, which may be due to the clinical ladder system still being implemented in Taiwan.

CONCLUSIONS

The nominal group technique is an efficient and proper method to conduct a consensus for specific issues or values among individuals and groups. The results of this study can facilitate the development of evaluation indicators or instruments as well as provide a direction of continuing education program for preceptor training.

Effectiveness of a standard clinical training program in new graduate nurses' competencies in Vietnam: A quasi-experimental longitudinal study with a difference-in-differences design

OBJECTIVE

This study aimed to estimate the effectiveness of a standard clinical training program for new graduate nurses in Vietnam.

METHODS

A quasi-experimental longitudinal study with a difference-in-differences design was conducted. A total of 280 new graduate nurses completed a self-administered questionnaire. The intervention group consisted of 206 respondents (those having participated in standard clinical training) and the control group (those that did not receive training) of 74. Differences in mean increases in competency scores between the intervention and control groups were estimated. The effect size of the intervention was estimated by calculating Cohen's d. A generalized linear model was employed to identify the factors associated with mean increases.

RESULTS

The mean increase in total competency scores (range: 0-6 points) in the intervention group was 0.73 points greater than in the control group with an intermediate effect size (Cohen's d = 0.53; 95% CI 0.26 to 0.80). A greater reduction in standard deviation of total competency scores in the intervention group was confirmed. Participation in standard clinical training produced a positive association with a mean increase in total competency score without significance (β = 0.04, P = 0.321). Provincial hospitals as clinical training venues had a significantly positive association (β = 0.11, P = 0.007) with the mean increase in total competency scores. Competency at pre-clinical training was negatively (β = -0.75, P < 0.001) associated with the mean increase.

CONCLUSION

Findings implied that the standard clinical training program could contribute to both increasing and standardizing new graduate nurses' competencies in Vietnam. Further studies are needed to more precisely examine the attribution of standard clinical training to better increase new graduate nurses' competencies.