Facing registration: the expectations and the unexpected

The personality of newly graduated and employed nurses: Temperament and character profiles of Swedish nurses

Background

One of the challenges of the 21st century is the high turnover rate in the nursing profession due to burnout and mental illness. From a biopsychosocial perspective, an individual's personality is an important vulnerability-resilience factor that comprises four temperament traits (i.e., a person's emotional reactions) and three character traits (i.e., self-regulation systems). Indeed, different personality profiles are associated to different coping strategies and health outcomes.

Objective

We investigated and mapped the temperament and character of Swedish newly graduated and employed nurses' in relation to the Swedish general population and an age-matched sub-sample.

Design

In this cross-sectional study, nurses self-reported their personality (Temperament and Character Inventory) at the beginning of their employment.

Setting

The data collection was conducted at a hospital in the South of Sweden.

Participants

A total of 118 newly graduated and employed nurses (Mage = 25.95±5.58) and 1,564 individuals from the Swedish general population participated in the study.

Methods

We calculated T-scores and percentiles for all seven personality dimensions using the Swedish norms (N = 1,564). The profiles were calculated by combining high/low percentiles scores in three temperament dimensions (Novelty Seeking: N/n, Harm Avoidance: H/h, and Reward Dependence: R/r) and in the three character dimensions (Self-Directedness: S/s, Cooperativeness: C/c and Self-Transcendence: T/t).

Results

Regarding T-scores, the nurses reported moderately lower Novelty Seeking (> 0.5 SD), slightly higher Harm-Avoidance (about 0.5 SD), moderately higher Persistence (> 0.5 SD) and Reward Dependence (> 0.5 SD), and extremely lower Self-Directedness (> 1 SD). The prevalence of the most common temperament profiles among the nurses (Swedish general population in brackets) were: 39.80% [10.90%] Cautious (nHR), 21.20% [10.90] Reliable (nhR), and 15.30% [16.50%] Methodical (nHr). The prevalence of the most common character profiles among the nurses were: 31.40% [4.90%] Dependent (sCt), 25.40% [14.40%] Apathetic (sct), and 19.50% [8.80%] Moody (sCT).

Conclusions

The analyses of the personality profiles showed that Low Novelty Seeking (79%), high Harm Avoidance (65%) high Reward Dependence (80%), low Self-Directedness (95%), and low Self-Transcendence (60%) were more prevalent among the newly graduated and employed nurses. This may partially explain newly graduated nurses' difficulties at work and high turnover rate. After all, a well-developed character is of special importance when working with patients with serious and terminal illness or under large global crises, such as the current pandemic. Hence, both education at universities and development at work need to be person-centered to reduce stress levels and promote positive self-regulation strategies.

Anaesthesia nursing competence: Self-assessment of nursing students

BACKGROUND

The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers.

OBJECTIVES

To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care.

DESIGN

Cross-sectional survey design.

METHODS

Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data.

RESULTS

The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence.

CONCLUSIONS

Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.

Transition shock and job satisfaction changes among newly graduated nurses in their first year of work: A prospective longitudinal study

AIMS

To identify the changes in transition shock and job satisfaction among newly graduated nurses during their first year and examine the factors affecting these changes.

BACKGROUND

Newly graduated nurses' high turnover is related to transition shock and job satisfaction. However, insufficient information exists on changes in these variables among such nurses.

METHODS

A prospective longitudinal design was used. Participants were nurses newly graduated from nursing schools and working in hospitals in South Korea. There were 312, 195 and 120 participants at 4, 8 and 12 months, respectively.

RESULTS

Transition shock and job satisfaction decreased as working period increased; transition shock was lower, and job satisfaction was higher in positive work environments. Linear mixed models revealed work environment was the only factor significantly related to transition shock and job satisfaction changes.

CONCLUSION

The nurses' transition shock and job satisfaction varied as per working period and work environment, which were the most important factors of these changes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can be aware of transition shock and job satisfaction changes, assess their severity and implement solutions in their hospitals. Thus, retention strategies should differ according to the changing needs of nurses at different stages of their career.

The experience of transition from nursing students to newly graduated registered nurses in Singapore

Objectives

To investigate the experience of newly graduated registered nurses (NGRNs) in Singapore following their initial 6–12 months of transition from nursing student to registered nurse.

Methods

This mixed-methods study consisted of two phases. In the first phase, data were collected via the administration of the online survey to 30 NGRNs. The questionnaire contained 42 items of the four-point Likert scale survey. In the second phase, a focus group interview was conducted with 5 NGRNs to gather complementary information regarding the major findings from the first phase.

Results

The survey revealed despite most NGRNs (80%) in this study expressed overall satisfied with their transition, the item score was (2.97±0.61) out of 4, the majority (83.3%) also perceived their transition to professional practice being stressful, the item score was (3.07±0.74) out of 4.Three themes emerged from the interview, ‘personal transition experience’, ‘professional transition experience’, and ‘organizational transition experience’, which are entwined to construct overall NGRNs’ transition experiences.

Conclusions

This study reaffirms the theory-practice gap phenomenon. This signifies the need for closer collaboration between educational, healthcare industry and regulatory stakeholders to examine and address factors that influence their transition experience to better support them for workforce readiness.

Building the English health visitor workforce as a result of the Health Visitor Implementation Plan 2011-2015: a survey study of career progression and retention for newly qualified health visitors

AIM

This study aimed to explore the extent to which health visitors who trained and qualified in both Greater London and the South West of England between September 2011 and January 2016 were employed in health visiting posts and have remained in the profession.

BACKGROUND

In 2011, the UK Government launched the Health Visitor Implementation Plan 'A Call to Action' (Department of Health, 2011) to develop the health visitor workforce by training 4200 health visitors over a four-year period. By April 2015, 4000 additional health visitors were trained, but the total workforce has since fallen back to pre-Implementation Plan size.

METHODS

Data were collected using a survey, completed online by participants. All participants had undertaken a health visitor education programme at one of two participating universities. The survey was distributed in January 2017 and completed by 180 individuals. Quantitative data were analysed using SPSS; association was assessed using individual chi-square tests or Fisher's exact test. Free-text responses were thematically analysed.

FINDINGS

Most (153; 87%) participants were still working as health visitors. Length of time spent working in the community prior to completing health visitor training was associated with staying in the role ( χ2 (with Fisher's exact test = 7.998, P = .027). Current pay was associated with attrition from the health visitor workforce ( χ2 (with Fisher's exact test) = 67.559, P < .001.). The majority who had left the health visitor role were on higher pay bands in their new post compared to those that had stayed (12; 60%). Bronfenbrenner's (1979) theory of socio-ecological development was used as a framework to interpret the results. While participants made an active choice to join the profession, leaving was influenced more by factors outside their control. To influence health visitor retention, both local and strategic changes are required.

Improving student nurses' confidence in managing the acutely ill patient

AIM

the Acute Illness Management (AIM) course was introduced into NHS trusts across Greater Manchester in 2002/03 for registered nurses. In preparation for the transition from student to registered nurse, the AIM course was then included in the final year of the undergraduate nursing programme. The aim of this study was to evaluate the impact of the AIM course on student nurses' confidence in managing the acutely ill patient.

METHOD

a quantitative approach was adopted. Ethical approval was granted by the Research and Ethics committee at the University of Salford.

RESULTS

a total of 192 student nurses attended the AIM course; 94% of the students completed a pre-course questionnaire and 100% completed the post-course questionnaire.

CONCLUSION

the evidence suggests a significant increase in the student nurses' confidence in recognising, responding and managing an acutely ill patient following the one-day course.

How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study

INTRODUCTION

On entry into the clinical environment, nursing students are confronted with many challenges. It is a common problem throughout the world, including Iran. Although many studies have been conducted on the problems of nursing students in the clinical environment, limited information is available on nursing students' experiences of the clinical learning environment and the way they respond to these experiences. Identifying nursing students' experiences is essential to develop interventions to reduce challenges.

OBJECTIVE

This study aimed to explore nursing students' experiences in a clinical learning environment and the way they responded to these experiences.

DESIGN

The present study was conducted based on the qualitative research design of the grounded theory methodology.

SETTING

This study was conducted at schools of nursing in academic settings in Iran.

PARTICIPANTS

The participants included 19 nursing students, 4 nursing instructors and 3 clinical nurses.

METHODS

The data were collected using semistructured interviews, field notes and observation, and were analysed using Strauss and Corbin's approach.

RESULTS

Students, as a result of the inadequacy of the educational environment, were faced with 'confusion of identity', stating this as their main concern. When confronted with this concern, they employed specific strategies, some of which prevented them from getting into unpleasant conditions. These strategies did not help students solve their problems and also prevented them from accepting their professional roles and responsibilities. Conversely, some other strategies led them to advanced professional development and enabled them to accept their role and the clinical environment.

CONCLUSION

According to the results of this study, educational policymakers should focus on improving the clinical environment. Identifying professional models and increasing their influence on management, education and clinical education, as well as teaching positive and constructive strategies, will promote positive strategies in coping with inadequate educational contexts. This is necessary for the professional development of nursing students.

A narrative study of newly graduated registered Swedish nurses' establishment in the profession and the portrayal of a healthcare organisation

PURPOSE

The purpose of this paper is to investigate how the participants talk about their experiences as newly graduated nurses, managers and nursing colleagues in the context of "newcomers' establishment in the profession" and to identify how they portray the healthcare organisation in their narratives.

DESIGN/METHODOLOGY/APPROACH

A narrative approach is used to reveal and illustrate three perspectives on the topic "new-comers' establishment". In total, 14 interviews are conducted with 4 managers, 4 nursing colleagues and 6 newly graduated registered nurses. The focus of this study is how a healthcare organisation embraces and retains newly graduated registered nurses and how this is perceived.

FINDINGS

The newcomers' establishment is facilitated by an orientation programme and an orientation period, individual support provided by managers and colleagues, and the creation of trust to boost confidence in nursing situations. The organisation is portrayed as struggling with high workloads, nursing shortages, high levels of responsibility and showing concern and an interest in the newcomer. The parties criticise the university for not teaching the most basic knowledge, thereby revealing the existence of a theory-practice gap.

ORIGINALITY/VALUE

The research shows how building trust amongst the organisation's members is essential for creating a satisfying workplace and the retention of newly graduated registered nurses. Empirical descriptions of newly graduated nurses, managers and nursing colleagues experiences of "newcomers establishment" are rare, which is why the description of such "establishment" in this research increases the value of the paper.

Final year pre-registration student nurses perceptions of which taught theoretical knowledge is important for practice

This research illuminates the perceptions of eighteen final year undergraduate pre-registration student nurses, to understand what theoretical knowledge was perceived to be useful during their pre-registration nursing education, and what was not. The research adopted a qualitative phenomenological approach, and utilised a sample size of eighteen final year student nurses as the data source. The data collection method consisted of semi-structured interviews and the study took place at a Higher Education Institution within the North West of England approved to provide pre-registration nurse education. Participants provided their data during their final year of their undergraduate pre-registration nursing programme, via semi-structured, digitally recorded interviews, which were transcribed verbatim. The transcribed interviews were then analysed using Interpretive Phenomenological Analysis. The findings generated three themes, these were; important knowledge to learn for everyday practice, irrelevant for my future role, and, can we have some more? Findings demonstrate what aspects of the taught curriculum student nurses perceive to be of use to their practice, and why they perceive this to be the case. This affects how student nurses approach their learning during their nursing education. In addition it was clear what participants perceived was not useful for their practice and why this was the case. Additionally, participants offered suggestions of what they would also like adding to their curriculum, and provided insights for what they would like adding to the curriculum, which can be used for enhancing this. This is useful when developing future curricula to understand which aspects student nurses learn in a deep and superficial way. This can provide a useful insight for to ensure that patient care is not compromised.

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Psychometric evaluation of the Environmental Reality Shock-Related Issues and Concerns instrument for newly graduated nurses

BACKGROUND

Reality shock is a critical representation of the gap between nursing education and clinical practice and it is important to explore the level of reality shock among nurses. However, there is no relevant instrument to assess the level of reality shock in South Korea.

OBJECTIVES

The purpose of this is to determine the validity and reliability of the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument.

DESIGN

A cross-sectional study design was used in this study.

SETTINGS

The data collection was conducted in selected 15 hospitals in South Korea.

PARTICIPANTS

A convenience sample of 216 newly graduated nurses participated in the study.

METHODS

The Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument was developed through the forward-backward translation technique, and revision based on feedback from expert groups. The internal consistency reliability was assessed using Cronbach's alpha, and the construct validity was determined via exploratory and confirmatory factor analysis.

RESULTS

The Korean version of the Environmental Reality Shock-Related Issues and Concerns has reliable internal consistency (Cronbach's alpha=0.91). Exploratory factor analysis revealed five factors including job, relationships, expectations, private life, and performance, which explained 61.92% of variance. The factor loadings ranged from 0.451 to 0.832. The five-factor structure was validated by confirmatory factor analysis (RMR<0.05, CFI>0.9).

CONCLUSION

It was concluded that the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument has satisfactory construct validity and reliability to measure the reality shock of newly graduated nurses in South Korea.

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

BACKGROUND

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

AIM

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

METHOD

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

RESULTS

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

CONCLUSION

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

Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration

AIMS AND OBJECTIVES

To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration.

BACKGROUND

Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions.

DESIGN/METHODS

A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis.

RESULTS

Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice."

CONCLUSIONS

Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.

Supporting completion of an online continuing professional development programme for newly qualified practitioners: A qualitative evaluation

BACKGROUND

Development programmes to support newly qualified practitioners gain confidence in their first professional role often show varied levels of engagement, due to competing priorities and demands. In Scotland, the Flying Start NHS® programme uses a structured programme of online and work-based learning with associated mentoring, to support individuals through an often difficult transition to become capable, confident practitioners. Whilst the programme was generally well received, the factors leading to widely varying completion rates between professions and organisations were not well understood.

AIM

The aim of this study was to identify the factors leading to successful completion of Flying Start, a transition programme for newly qualified practitioners.

METHOD

A qualitative approach was adopted to gather data from two groups of participants. Semi-structured telephone interviews were conducted with strategic and management level participants (n=23), from five health boards in Scotland. Semi-structured interviews (n=22) and focus groups (n=11) were conducted with practitioners within 6months either side of completing the programme. The interviews were transcribed and analysed using framework analysis.

RESULTS

Three key themes relating to successful completion emerged from the analysis: Management and Delivery; Content and Material; Participation and Completion. Factors leading to successful completion were identified at programme, organisational and individual levels. These included clear communication and signposting, up-to-date and relevant content, links with continuing professional development frameworks, effective leadership, mentor and peer support, setting clear standards for assessment, and facilitating appropriate IT access.

CONCLUSIONS

A strong strategic commitment to embedding a development programme for newly qualified practitioners can ensure that the necessary support is available to encourage timely completion. The mentor's role - to provide face-to-face support - is identified as a key factor in completion and is achieved through setting attainable targets, monitoring progress, and providing motivation. However organisational structures that facilitate the mentoring relationship are also necessary.

Emotional Support for New Graduated Nurses in Clinical Setting: a Qualitative Study

Introduction: Newly graduated nurses experience many stressful situations during transition to practice. The provision of emotional support from more experienced nurses can ameliorate such work-related tension. Studies have not clearly specified the means through which such support could be most effectively provided; therefore the present study was conducted to explore the experiences of qualified nurses around the provision of emotional support to newly graduated nurses.

Methods: This qualitative study was conducted through semi-structured interviews with 18 qualified nurses. A purposive sampling approach was used for selection of participants. Interviews were transcribed verbatim and analyzed by the conventional content analysis method. The study took place from 2014-2015 in six teaching hospitals in the northwest of Iran.

Results: Emotional supports emerged in four following main-categories: Assurance, creating a sense of relaxation and security, lifting spirits, and emotional belonging and involvement.

Conclusion: These results can help to establish an effective source of emotional support for newly graduated nurses. This can play an important role in reducing their stress and anxiety, in increasing their self-confidence and in forming a constructive relationship between them and qualified nurses.

Attitude to the subject of chemistry in undergraduate nursing students at Fiji National University and Federation University, Australia

Attitude to the subject of chemistry was quantified in first-year undergraduate nursing students, at two geographically distinct universities. A purpose-designed diagnostic instrument (ASCI) was given to students at Federation University, Australia (n= 114), and at Fiji National University, Fiji (n=160). Affective and cognitive sub-scales within ASCI showed reasonable internal consistency. Cronbach's alpha for the cognitive sub-scale was 0.786 and 0.630, and 0.787 and 0.788 for affective sub-scale for the Federation University and Fiji National University students, respectively. Mean (SD) score for the cognitive sub-scale was 10.5 (5.6) and 15.2 (4.1) for students at Federation University and Fiji National University, respectively (P<0.001, t-test). Mean (SD) score for the affective sub-scale was 13.1 (5.1) and 20.7 (4.3) for students at Federation University and Fiji National University, respectively (P < 0.001, t-test). An exploratory factor analysis (n=274) confirmed a two-factor solution consistent with affective and cognitive sub-scales, each with good internal consistency. Quantifying attitude to chemistry in undergraduate nursing students using ASCI may have utility in assessing the impact of novel teaching strategies used in the education of nursing students in areas of bioscience and chemistry. However, geographically distinct populations of undergraduate nurses may show very different attitudes to chemistry.

A critical analysis of the literature and theoretical perspectives on theory-practice gap amongst newly qualified nurses within the United Kingdom

OBJECTIVES

This critical analysis of the literature examines the factors and theoretical perspectives contributing to the theory-practice gap for newly qualified nurses within the United Kingdom. This article aspires to inform, guide and promote effective nursing education both academically and practically.

DESIGN

A systematic search strategy was conducted to identify relevant literature covering the period of 2000-2014, to include only contemporary theoretical perspectives coinciding with the dearth of contemporary literature post Project 2000.

DATA SOURCES

The literature was systematically investigated utilising nursing research databases, the Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine, the U.S. National Library of Medicine and Internurse.

REVIEW METHODS

To satisfy the search criteria only articles conducted within the United Kingdom and written in the English language were included. Only literature including nurses and newly qualified nurses were included. To identify relevant literature a series of key words were utilised.

RESULTS

Systematic review of the literature revealed that newly qualified nurses feel unprepared for practice, lacking confidence in their own abilities. It was also felt by newly qualified nurses that not enough time was dedicated to the production of clinical skills during their training. The use of preceptorship programmes was found to reduce the transitional stress associated with becoming a qualified nursing practitioner.

CONCLUSIONS

Despite the increasing research being undertaken in the area of theory-practice gap there is still a need for nursing educators, practice areas and regulatory bodies to invest further in research. The effects of preceptorship and simulation exercises in particular require more research to provide regulatory bodies with enough evidence to make an informed decision as to whether their use should be mandatory.

Application of best practice guidelines for OSCEs-An Australian evaluation of their feasibility and value

BACKGROUND

Objective Structured Clinical Examinations (OSCEs) are widely used in health professional education and should be based on sound pedagogical foundations.

OBJECTIVES

The aim of this study is to evaluate the feasibility and utility of using Best Practice Guidelines (BPGs) within an OSCE format in a broad range of tertiary education settings with under-graduate and post-graduate nursing and midwifery students. We evaluated how feasible it was to apply the BPGs to modify OSCEs in a course; students' perspective of the OSCE; and finally, if the BPG-revised OSCEs better prepared students for clinical practice when compared with the original OSCEs.

DESIGN

A mixed method with surveys, focus groups and semi-structured interviews evaluated the BPGs within an OSCE.

SETTINGS

Four maximally different contexts across four sites in Australia were used.

PARTICIPANTS

Participants included lecturers and undergraduate nursing students in high and low fidelity simulation settings; under-graduate midwifery students; and post-graduate rural and remote area nursing students.

RESULTS

691 students participated in revised OSCEs. Surveys were completed by 557 students; 91 students gave further feedback through focus groups and 14 lecturers participated in interviews. At all sites the BPGs were successfully used to modify and implement OSCEs. Students valued the realistic nature of the modified OSCEs which contributed to students' confidence and preparation for clinical practice. The lecturers considered the revised OSCEs enhanced student preparedness for their clinical placements.

DISCUSSION AND CONCLUSIONS

The BPGs have a broad applicability to OSCEs in a wide range of educational contexts with improved student outcomes. Students and lecturers identified the revised OSCEs enhanced student preparation for clinical practice. Subsequent examination of the BPGs saw further refinement to a set of eight BPGs that provide a sequential guide to their application in a way that is consistent with best practice curriculum design principles.

Newly qualified nurses' experiences of a preceptorship

RESEARCH QUESTION

What was the experience of preceptorship like for newly qualified registered nurses in a healthcare trust?

METHOD

A qualitative approach was used with data collected using semi-structured one-to-one interviews with eight participants who had recently completed their preceptorship period. The data was analysed using Newell and Burnard's (2011) Pragmatic Approach to Qualitative Data Analysis, which involved a six-stage analysis process.

FINDINGS

Two main categories emerged from the data. These were Support Requirements and Expectations of Preceptorship. Support was further broken down into two themes: time and build confidence. Expectations of preceptorship was further broken down into two themes; understanding the process and understanding the preceptor's role.

CONCLUSION

The participants felt that preceptorship offered support and helped them in developing their confidence in the transition to registrant. It would appear that consistency of provision of preceptorship is a key issue that would warrant further study.

People, liminal spaces and experience: understanding recontextualisation of knowledge for newly qualified nurses

BACKGROUND

Little is known about how newly qualified nurses delegate to health care assistants when delivering bedside care.

AIM

To explore newly qualified nurses' experiences of delegating to, and supervising, health care assistants.

DESIGN

Ethnographic case studies.

SETTINGS

In-patient wards in three English National Health Service (NHS) acute hospitals.

PARTICIPANTS

33 newly qualified nurses were observed, 10 health care assistants and 12 ward managers.

METHODS

Participant observation and in-depth interviews.

FINDINGS

We suggest that newly qualified nurses learn to delegate to, and supervise, health care assistants through re-working (`recontextualising') knowledge; and that this process occurs within a transitional (`liminal') space.

CONCLUSIONS

Conceptualising learning in this way allows an understanding of the shift from student to newly qualified nurse and the associated interaction of people, space and experience. Using ethnographic case studies allows the experiences of those undergoing these transitions to be vocalised by the key people involved.

The theory of organisational socialisation and its potential for improving transition experiences for new graduate nurses

BACKGROUND

Graduate nurse transition continues to remain a difficult time for many new graduate nurses, with significant numbers of graduates being dissatisfied, ultimately considering leaving or exiting the profession. Currently, many graduate nurse programs within Australia and internationally reflect a homogeneous nature pertaining to content and program delivery. A refinement of graduate nurse transition programs through an adaptation of a model of organisational socialisation supports a more individualised approach to transition, improving graduate outcomes and addressing attrition rates.

OBJECTIVES

To propose a model which supports the accommodation of new graduates within a health service improving both new graduate and health service outcomes through; greater levels of job satisfaction, increased commitment to an organisation and decreased turnover of new staff.

DESIGN

Theoretical paper based on a program of research.

METHODS

An adaptation of a model of organisational socialisation was applied to the process of transition for newly qualified graduate nurses. This adaptation was informed by a larger 2012 Australian study (findings reported extensively elsewhere) with 459 newly qualified graduate nurses reporting their transition experiences of the first year of practice.

RESULTS

Newly qualified graduate nurses reported effective socialisation with transition based on the following; enduring and continuous orientation throughout the first year of practice, allocation of patient responsibilities reflecting a level of acuity commensurate with a beginning skill set to meet care needs, and feedback of a respectful nature to improve confidence and competence in practice. Negative transition experiences were noted by many new graduates if these factors were not considered.

CONCLUSIONS

Graduate nurse turnover is costly and destabilising for health services. One means of addressing this is the creation of positive working environments which appropriately socialise new graduates into health services. Accommodating new employees through; individual recognition, modelling of behaviours and developing positive transition outcomes will improve graduate nurse satisfaction and importantly retention.

Self-assessed level of competence of graduating nursing students and factors related to it

BACKGROUND

The transition from a nursing student to a professional nurse is both challenging and stressful. Competence of graduating nursing students is related to patient safety and there is a need for assessment of competence. However, there is a lack of research on the level of competence at the moment of graduation.

OBJECTIVES

To describe the level of competence of graduating nursing students based on students' self-assessments and to identify possible related factors.

DESIGN

Cross-sectional survey design.

METHODS

The data were collected using an on-line survey (the Nurse Competence Scale) in 2011 and administered to 302 graduating nursing students in Finland practicing in their final clinical placement in university hospitals. The sample contained 154 students (response rate 51%). The data were analyzed statistically.

RESULTS

The self-assessed overall competence was on good level (66.7, VAS 0-100). The competence was highest in helping role and in diagnostic functions, being slightly lower in therapeutic interventions and work role. Pedagogical atmosphere during the final clinical placement had a statistically significantly positive correlation with the overall level of competence.

CONCLUSIONS

Graduating nursing students have good competence at the moment of graduation based on their self-assessments. Self-assessment is a basis for competence development, and systematic self-assessments should be used during the education. Teacher and supervisor assessments and knowledge-tests could be used alongside with self-assessments of competence to give a wider picture of the competence.

Novice nurses' experiences of unpreparedness at the beginning of the work

Introduction:

Unpreparedness of novice nurses during the process of transition to their professional role can has broad consequences for the nurse and health care system and leads to reduction of the quality of patient care. This study has been carried out with the aim of investigating the experiences of the unpreparedness of novice nurses.

Method:

This study was conducted qualitatively by using conventional content analysis. Participants were 21persons including 17 novice nurses, 2 supervisors, and 2 experienced nurses who were selected through purposeful sampling from four hospitals dependent on Tehran University of Medical Sciences.

Findings:

Participants' experiences were reflected in three main themes of "functional disability", "communicative problems", and "managerial challenges". Each of these dimensions consisted of several sub-categories. These areas had represented the inability to apply the learned knowledge in practice.

Discussion:

The sensitivity of health system, especially, educational mentors and nursing managers to create preparation in novice nurses by providing appropriate orientation programs at the beginning of work and the revision and amendment of nursing curriculum can solve this problem to some extent.

A Narrative Exploration

Experienced nurses are repeatedly asked to mentor and to work with new graduate nurses in intensely busy hospital environments. To gain an understanding of experienced nurses’ perspectives of working with new graduates, eight nurses were interviewed from two hospitals in Eastern Canada. Narrative analysis revealed that experienced nurses prepared in advance for new graduates’ arrival and felt their workload increased when new graduates actually began to practice. Experienced nurses expressed verbal support for new graduates and yet their stories did not all reflect supportive comments. Themes identified were New Graduates Are Coming, Keeping Us on Our Toes, and Carrying the Load. Findings provide valuable information to help nurses, educators, and managers gain a new understanding of what it is like for experienced nurses working with new graduates. There are important implications for managers in how to support experienced nurses as they work alongside new nurses.

Lost in transition--a review of qualitative literature of newly qualified Registered Nurses' experiences in their transition to practice journey

The failure of newly qualified Registered Nurses to be appropriately transitioned into the new practice has been mentioned in numerous nursing literatures. Along with the need to decrease turnover rates, increase satisfaction rate of nurses and improve patient outcomes, nursing educators in Singapore are interested in the experiences of these nurses in their transition to practice journey. In this paper, the author attempts to critically review qualitative research conducted in that area to identify why nurses are leaving the profession and how nursing educators in Singapore can reduce stress and uncertainty in the newly qualified Registered Nurses during their transition to practice journey. In conducting a qualitative literature review, the author aims to explore interpretation of these nurses' subjective experiences and description of their social context, ultimately paying attention to lay knowledge as human behaviour is context specific rather than being represented in the quantitative form.

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

AIMS AND OBJECTIVES

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

BACKGROUND

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSION

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

RELEVANCE TO CLINICAL PRACTICE

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

Does an Immediate Life Support (ILS) course enhance clinical practice? The students' perceptions

This descriptive study evaluates whether the Immediate Life Support (ILS) course enhanced final year adult branch nursing students' ability to assess and initially manage the care of deteriorating patients. A thirty point likert scale questionnaire was used to collect quantitative data from final year adult branch nursing students in one Higher Education Institution in the United Kingdom. A comment box permitted the compilation of qualitative remarks. An 84% (n=149) response rate was achieved. The responses demonstrated a positive endorsement of the ILS course as part of the final year adult branch programme. Data also suggested that knowledge and skills learned during the ILS course were extremely useful for students and enhanced their clinical practice. Findings indicate that providing students with the opportunity to participate in the ILS course enhanced their ability to practice in a more confident manner. Furthermore, findings suggest that undertaking the ILS course provides the student with the skills to recognise the deteriorating patient and may have the potential of improving patient care. New knowledge from this research suggests that the ILS course does prepare students for practice and may go some way to assist students make the transition from student to registered nurse.

What is provided and what the registered nurse needs--bioscience learning through the pre-registration curriculum

Registered nurses undertaking programmes of study to become non-medical prescribers appear to have limited biological science knowledge. A case study was undertaken to determine whether the nurses entering Prescriber programmes considered studies in bioscience in their pre-registration nursing courses had been sufficient, linked to practice, and had prepared them for their roles as registered nurses. The literature identifies a continuing trend amongst nursing students describing a lack of sufficient bioscience in initial nurse education; there is limited literature on the views of experienced registered nurses. The participants in this study were 42 registered nurses from adult and mental health nursing, community and inpatient services. The results obtained from questionnaires and interviews are described. Questionnaire analysis identified that 57.1% of participants indicated bioscience in their pre-registration nursing programme had been limited and 40.5% stated the bioscience content had not prepared them for their roles on registration. Those reporting extensive coverage of bioscience were all aged over 41 years and had qualified before 1995. Greatest coverage of bioscience in pre-registration programmes was reported in relation to anatomy and physiology, with relatively limited coverage of microbiology, pharmacology or biochemistry. Respondents considered all five topics to be important. Interviews supported the questionnaire findings.

Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.