The new graduates’ professional inheritance

New to the community setting: nurses' experiences and the importance of orientation

There has been little research about the experiences of nurses transitioning into community nursing (CN), despite the growing demand for nurses in this setting and impending shortfall in the nursing workforce in Australia. In this study, nurses from a busy metropolitan CN service were interviewed to explore how they experienced their first months in their new role. The interviews were analysed thematically, with three themes emerging: Adaptation, Focus of Care and Context. Participants detailed their experiences adjusting to new work practices and the community setting, and expanded on their enjoyment from increased autonomy, career goal recognition and rewarding patient relationships and outcomes. The findings of this study are aligned with previous literature about nurses entering the primary healthcare setting from acute care, and particularly highlight the need to individually tailor orientation, preceptorship and ongoing career development programs to each nurse.

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

Aims

Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions.

Design

The study used an observational cohort design.

Methods

Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013–September 2014.

Results

Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work‐life imbalance; only conflicting job demands, and lack of control related to professional commitment directly.

Conclusion(s)

To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events.

Impact

Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.

Experiences of registered nurses in a general practice-based new graduate program: a qualitative study

Nurses are increasingly needed in primary healthcare settings to support community-based healthcare delivery. Programs to facilitate transition of new graduate nurses are well established in acute care; however, there are few similar programs reported in settings like general practice. This paper sought to explore the experiences of new graduate registered nurses and their registered nurse mentors in a new graduate program within Australian general practice. New graduates (n = 9) and their mentors participated in interviews before, during and at the conclusion of a 12-month new graduate program. Interviews were digitally audio-recorded and professionally transcribed verbatim before being analysed using thematic analysis. Eighteen new graduate and 10 mentor interviews were conducted, revealing four themes. Preparation and Opportunities describes the influence that pre-registration education had on preparing nurses for general practice employment. Exceeding Expectations highlights the positive experiences within the program. Program Challenges draws attention to the difficulties experienced by participants, and Future Career Intentions explores future career plans. This study highlights that a general practice new graduate nurse program has the potential to build the workforce. However, strengthening undergraduate preparation of nurses around primary health care and addressing funding issues in general practice, are important to promote the success of such programs.

Benner's model and Duchscher's theory: Providing the framework for understanding new graduate nurses' transition to practice

The transition to quality and safety in the new graduate registered nurses' practice remains problematic directly impacting patient outcomes. Effective mentoring during transition serves to enhance experiential learning, allowing the development and establishment of safe, quality nursing practice. Comprehensive understanding of the transition process, including the barriers and effective enablers to transition is the key to effective mentoring. A theoretical framework guided by Duchscher's Stages of Transition Theory and Transition Shock Model and Benner's From novice to expert model can facilitate such understanding. Nurse Theorists play an important part in shaping nurse education and practice and have provided nurse educators and leaders an understanding to shape skill acquisition and the transition process for new graduate registered nurses. The res ultantresearchmodels and theory of these influencial nurses are pertinent to transition of new graduate registered nurses. This paper outlines the theories of Duchscher and Benner and how their research formed the theoretical framework to facilitate the measurement, understanding and improvement of the safety and quality of nursing care and impact the future nursing workforce.

Integrating a Career Planning and Development Program into the Baccalaureate Nursing Curriculum. Part II. Outcomes for New Graduate Nurses 12 Months Post-Graduation

New graduate nurses' (NGNs) transition into the nursing workforce is characterized as stressful and challenging. Consequently, a high percentage of them leave their first place of employment or the profession entirely within one year of graduation. Nursing literature describes this complicated shift from student to registered nurse, however, limited attention has focused on strategies that could be implemented during students' academic programs to prepare them for this difficult transition period. Therefore, a longitudinal intervention study was conducted to examine the influence of a career planning and development (CPD) program on the development of career resilience in baccalaureate nursing students and at 12 months post-graduation (NGN). The findings support including structured and progressive curriculum-based CPD opportunities in academic programs, not only for the positive outcomes that accrue to students, but also because of the benefits they extend to NGNs as they make the transition to their first professional nursing role.

A contemporary examination of workplace learning culture: an ethnomethodology study

BACKGROUND

Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be 'engaged', that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a 'good' learning environment, ongoing issues continue to challenge healthcare organisations and educators. A 'good' learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices.

OBJECTIVES

This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a 'good' workplace learning culture for both nursing students and qualified nurses.

DESIGN

An ethnomethodology study.

SETTING

A range of clinical settings in Victoria and Queensland, Australia.

PARTICIPANTS

Students and registered nurses (n=95).

METHODS

Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted.

RESULTS

Three central themes: learning by doing, navigating through communication, and 'entrustability', emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace.

CONCLUSIONS

Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously.

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.

Recent graduate nurse views of nursing, work and leadership

AIMS AND OBJECTIVES

To assess recent nurse graduates of a large university and seeks their views of university preparation, requisite nursing skills and qualities, workplace transition, supports received, nurse leadership and role models, and career development and retention.

BACKGROUND

Concern about attracting and retaining registered nurses is a continuing workforce issue in parts of Asia and throughout the world.

DESIGN

Qualitative interviews with recent nursing graduates.

METHODS

Seventeen face-to-face interviews took place using a structured schedule of 23 questions. Data were coded and analysed by hand to determine clusters of interest and develop themes.

RESULTS

Four broad topics emerged: (1) skills and qualities graduates consider central to nursing; (2) the support they received during the transition from graduate to novice practitioner and that which continues; (3) elements they value in nursing role models and leaders; and (4) the ward characteristics that will encourage them to remain in nursing and develop a career. Interviewees expressed concerns about retention-related issues, making suggestions for improvements. Unique findings focus on the blaming culture that many respondents consider they are working in, and the system whereby they are not free to access postgraduate studies until a specific time frame has elapsed, and when they do pursue further studies, they are bonded to the auspicing hospital/health service.

CONCLUSIONS

Responses unique to this research are the explicit concerns about a blaming culture, and complaints about rigid rules (bonding system) that virtually prevent an individual from accessing postgraduate studies independent of the hospital system. Interviewees strongly resent the bonding system that indentures them to that place of work.

RELEVANCE TO CLINICAL PRACTICE

Quality health care is dependent on a well-educated, sustainable and skilled nursing workforce. Recognition of the concerns of newly graduated nurses in relation to nursing skill acquisition, workplace support issues and career concerns can assist in ensuring these issues are adequately addressed and in turn contribute to a stronger, more stable and competent nursing workforce.

Family nursing: walking the talk

This article discusses a study exploring the lived experience of family nursing for novice registered nurses. There has been an increased emphasis on including family content in Canadian nursing education curricula. Literature on family nursing is ambiguous about differentiating family nursing at the generalist and specialist level, and acknowledges that there is a blurring of lines between the two. The study utilized a phenomenological approach to examine how nurses with 2 years or less in practice experience family nursing in a variety of settings. Following ethical approval, invitations were sent to all nurses employed in two health authorities, who met the study criteria. Five nurses were interviewed using a semistructured interview. Participants shared how they practice family nursing in the current nursing situation of shortages and constraints. This study adds to our understanding of what happens at a beginning level of family nursing, how nurses understand and experience caring for families in the everyday enactment of their professional role, and barriers and facilitators to including family in nursing care. The findings provide important information for nurse educators in grounding the teaching of family nursing in the real world of nurses.

New graduate nurse practice readiness: perspectives on the context shaping our understanding and expectations

Workforce shortages, fiscal restraint, complex healthcare organizations, increasing patient acuity, the explosion of knowledge and technology and the ever expanding role of nurses in healthcare have reinforced the importance of new graduates arriving in the work setting with the ability to move seamlessly into practice. This idea of moving seamlessly into practice is often referred to as practice readiness. Differing perspectives exist between nurses in the practice and education sector about the practice readiness of new graduates. The aim of this study was to understand the perspectives of nurses about new graduate nurse practice readiness and the underlying context shaping these perspectives. Focus groups involving 150 nurses with varying years of experience in the practice, education and regulatory sector were conducted. The findings revealed that participants' expectations and understandings of new graduate practice readiness were influenced by the historical and social context within which nursing education and professional practice is grounded. These differences centered around three main areas: the educational preparation of nurses (diploma or degree), the preparation of the technical versus the professional nurse, and the perceived responsibilities and accountabilities of the education and practice sector for the educational preparation of nurses. To shift the discourse around practice readiness, nurses from all sectors must focus on unique, innovative and cooperative solutions to ensure the seamless transition of all nursing graduates in the 21st century healthcare system.

Journeying through clinical placements--an examination of six student cases

INTRODUCTION

How student nurses are permitted to participate in healthcare settings during placements is central to their skill development, formation of occupational identity and retention in nursing. Novices' participation and learning was mapped through their clinical experiences from student to graduate, as part of a multi-method longitudinal study examining nurses' workplace learning.

METHODS

Twenty-nine second and third year nursing students participated in a series of interviews over a two year period. Six students, representing a cross-section of a student cohort form the basis of this case study. Interviews were transcribed verbatim and thematically coded.

RESULTS

Four themes encapsulating the participants' journeys through clinical situations were identified; (a) creating learning opportunities, (b) gaining independence, (c) becoming part of the team and (d) generational differences. The themes reflect the development of novice nurses and the nuances of the workplace as a learning environment.

DISCUSSION

The cases highlight the importance of supportive placements that comprise openness with opportunities, tolerance of inter-generational differences and invitations to become part of the nursing team. The challenge for nurse educators is how to best prepare students for the complexities of the social, cultural and political arena of clinical practice.

Creating a healthy workplace for new-generation nurses

PURPOSE

To examine dimensions of the psychosocial work environment that influence the psychological health of new-generation nurses.

BACKGROUND

While much work has been done concerning the health of nurses in general, research on the relationship between the nursing work environment and the psychological well-being of new-generation nurses at the start of their careers is limited.

DESIGN

A correlational descriptive design was used for this quantitative study. Survey data were collected from new nurses (N=309) whose names were obtained from a provincial licensing registry in Quebec, Canada.

FINDINGS

Among new nurses, 43.4% stated that they have a high level of psychological distress. These nurses were significantly more likely to perceive an imbalance between effort expended on the job and rewards received, low decisional latitude, high psychological demands, high job strain, as well as low social support from colleagues and superiors (p < or = 0.05).

CONCLUSIONS

Understanding the relationship between the work environment and health as experienced by new-generation nurses is imperative for creating interventions to successfully recruit and retain these young nurses.

CLINICAL RELEVANCE

Generation Y nurses in Quebec, faced with high levels of psychological distress because of their exposure to difficult nursing work environments, might leave the profession thereby exacerbating an already salient nursing shortage.

Clinical Focus Program

The Clinical Focus Program was designed to prepare senior nursing students for the transition to practice in the hospital setting. Through a series of 1:1 precepted clinical experiences, the students developed a broad base of clinical competencies and self-confidence in their nursing skills. Hospitals experienced reduced costs related to orientation and recruitment of new graduate nurses. The program also was valuable in building a network of collegiality and scholarship between education and practice environments.