Transition to Specialty Practice Program characteristics and professional development outcomes

Development of an Emergency Nurse Internship to Promote a Healthy Work Environment and Improve Nurse Retention

INTRODUCTION

Following the COVID-19 pandemic, a community emergency department was facing a staffing crisis with new emergency registered nurse turnover rates as high as 83.3%. There were limited experienced emergency nurses available to train the large number of novice nurses hired to fill vacancies. Based on this, the emergency department needed to restructure the orientation process to better align with evidence-based strategies and available resources.

METHODS

The Seven Steps of Evidenced-based Practice were used to identify the best practices for an orientation program specific to the emergency department. Based on the evidence, a 16-week, competency-based, emergency nurse internship was implemented in the 33-bed community emergency department.

RESULTS

The primary outcome of this initiative was new emergency nurse retention, which demonstrated a statistically significant reduction from 81.8% (pre-intervention) to 11.1% (post-intervention) (P < .001). Additionally, there was an improvement in the scores for each of the 6 healthy work environment standards.

DISCUSSION

Based on the outcomes of this initiative, an emergency nurse internship is an effective method to improve emergency nurse competence and retention, contributing to a healthier work environment.

Nurses’ experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study

Background

The shortage of psychiatric nurses is a major healthcare challenge. Lack of interest (LOI) contributes to the shortage of psychiatric nurses. Nonetheless, there are limited studies in this area. The present study was conducted to explore nurses’ experiences of the causes of their LOI in working in psychiatric wards.

Methods

This qualitative study was conducted in 2016–2019 using the content analysis approach. Participants were 27 nurses purposively recruited with maximum variation from the psychiatric wards of three referral hospitals in Iran. Data were collected via unstructured interviews and were concurrently analyzed using the conventional content analysis approach recommended by Graneheim and Lundman.

Results

The causes of participants’ LOI in working in psychiatric wards were grouped into three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitude towards psychiatric nurses, and concerns over patients.

Conclusion

This study suggests that the causes of nurses’ LOI in working in psychiatric wards are not only personal, but also social and organizational. Findings help managers and authorities develop strategies to increase psychiatric nurses’ interest in working in psychiatric wards through improving their work conditions and professional knowledge and skills.

Nurses' experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study

Background

The shortage of psychiatric nurses is a major healthcare challenge. Lack of interest (LOI) contributes to the shortage of psychiatric nurses. Nonetheless, there are limited studies in this area. The present study was conducted to explore nurses’ experiences of the causes of their LOI in working in psychiatric wards.

Methods

This qualitative study was conducted in 2016–2019 using the content analysis approach. Participants were 27 nurses purposively recruited with maximum variation from the psychiatric wards of three referral hospitals in Iran. Data were collected via unstructured interviews and were concurrently analyzed using the conventional content analysis approach recommended by Graneheim and Lundman.

Results

The causes of participants’ LOI in working in psychiatric wards were grouped into three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitude towards psychiatric nurses, and concerns over patients.

Conclusion

This study suggests that the causes of nurses’ LOI in working in psychiatric wards are not only personal, but also social and organizational. Findings help managers and authorities develop strategies to increase psychiatric nurses’ interest in working in psychiatric wards through improving their work conditions and professional knowledge and skills.

Communication, leadership and organizational support facilitate successful transition into practice for nurse practitioners in the emergency department

BACKGROUND

Postgraduate programs, specialized academic programs, and national health organizations such as the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills, and factors for successful transition into practice.

PURPOSE

The purpose of this study is to examine the relationships and differences among the personal and community resources that promote successful transition for nurse practitioners (NP) who practice in the emergency department (ED) and the skills or procedures they find difficult to perform independently.

METHODS

A descriptive, correlational, comparative study design was conducted using an online survey administered to a convenience sample of NPs with 6 months to 5 years of experience as an NP.

RESULTS

Findings from this study identified factors associated with successful and unsuccessful transition into practice and help support positive outcomes for health care institutions, ED patients, and NPs practicing in this specialty area.

IMPLICATIONS FOR PRACTICE

Support in transition recognizes recommendations set by health care organizations in promoting professional development, safe clinical practice, job satisfaction, and retention. Further study will provide clarity in financial gains and improved patient health outcomes during a time in which complex disease processes and provider shortages continue to weigh heavily on society.

Caring for deteriorating paediatric patients in the emergency department: A mixed method study

BACKGROUND

Paediatric presentations to emergency departments are common for a range of conditions with varying severity. Children can compensate well and early signs of deterioration may not be obvious. Nurses working in emergency departments (ED) should not only have the knowledge and skill to recognise the unwell child, but also be confident and competent to provide care.

AIM

To explore the self-reported preparedness, confidence and competence of emergency nurses in caring for deteriorating paediatric patients, and to identify how their confidence and competence could be improved.

METHODS

An exploratory sequential mixed methods study with two phases was used. In Phase One, qualitative data were collected via focus group and thematically analysed. The findings from Phase One informed Phase Two survey development, with quantitative data collected and analysed.

RESULTS

Findings from both phases identified that emergency nurses' confidence and competence when caring for deteriorating paediatric patients did not correlate with their level of qualification. In contrast, increased years of experience in caring for this cohort did increase level of confidence. Availability of human resources further impacted nurses' confidence when caring for deteriorating paediatric patients and emergency nurses showed an interest and enthusiasm for further education in caring for the deteriorating paediatric patient.

CONCLUSIONS

Regular exposure to paediatrics was key to nurses having confidence and competence to care for deteriorating patients, irrespective of educational qualifications. A focus on interprofessional insitu simulation could address human resource challenges to enhance skill development.

Academic and professional characteristics of Australian graduate emergency nursing programs: A national study

BACKGROUND

Specialist graduate emergency nursing education programs are essential to the delivery of high quality and safe healthcare to patients with complex needs in emergency care. Little is known about tertiary emergency nursing programs in Australia. This study aimed to determine the academic and professional characteristics of Australian emergency programs.

METHOD

This embedded mixed-method study examined the academic and professional characteristics of Australian emergency programs in two interdependent phases: (1) document and content analysis of Australian graduate emergency nursing program websites; and (2) semi-structured interviews with the associated convenors. The data underwent framework analysis using eight pre-identified categories of (i) course entry, (ii) fee arrangement, (iii) mode of delivery, (iv) volume of learning, (v) clinical assessment, (vi) employment requirements, (vii) graduate expectations, and (viii) influence of healthcare employers and professional engagement.

RESULTS

Prior clinical experience and the requirement for concurrent practising in an emergency care environment influenced were common, however fee arrangements were not clearly articulated. The College of Emergency Nursing Australasia Practice Standards for the Emergency Nursing Specialist featured in part within 12 programs, principally to guide development of clinical assessments.

CONCLUSION

Establishment of emergency nursing graduate practice standards could better inform the design and delivery of emergency nurse programs, and yield benefits in terms of graduate expectations and satisfaction and improved patient care.

Infusing the Principles of Trauma-Informed Care Into Emergency Nursing: A Comprehensive Approach to Change Practice

The emergency department is a frequent entry point into the healthcare system for victims of violence. Currently, a knowledge deficit and clinical practice gap exists among emergency nurses regarding their consistent ability to implement a trauma-informed approach in their interactions with forensic clients. Emergency nurses at all levels of professional development, senior undergraduate nursing students, new graduate nurses, and experienced nurses should be well informed regarding the prevalence of violence, basic clinical forensic nursing practice, and the principles of trauma-informed care. A comprehensive approach is required to both identify and address the trauma associated with violence. Through reflecting on Benner's Novice to Expert framework, strategies are proposed for the implementation of a comprehensive plan. An inclusive approach to the implementation of the principles of trauma-informed care into emergency nursing may ultimately lead to a transformation in culture in which nurses ask, "What has happened to you?" instead of "What is wrong with you?"