Transition to Practice in Nonhospital Settings

Effectiveness of formal onboarding for facilitating organizational socialization: A systematic review

OBJECTIVE

To investigate the effectiveness of formal onboarding programs and practices for new professionals.

INTRODUCTION

New professionals may experience high levels of stress and uncertainty. Formal onboarding programs and practices aim to facilitate the socialization of new professionals by structuring early experiences. However, there is a lack of evidence-based recommendations of how to onboard new professionals.

METHODS

This review considered studies that compares the effect of formal onboarding practices and programs for new professionals between 18-30 years of age (sample mean) to the effect of informal onboarding practices or 'treatment as usual' in professional organizations internationally. The outcome of interest for the review was the extent to which new professionals were socialized. The search strategy aimed to locate both published studies (dating back to year 2006) and studies accepted for publication written in English using the electronic databases Web of Science and Scopus (last search November 9 2021). Titles and abstracts were screened and selected papers were assessed by two independent reviewers against the eligibility criteria. Critical appraisal and data extraction were performed by two independent reviewers using Joanna Briggs Institutes templates. The findings were summarized in a narrative synthesis and presented in tables. The certainty of the evidence was assessed using the grading of recommendations, assessment, development and evaluations approach.

RESULTS

Five studies including 1556 new professionals with a mean age of 25 years were included in the study. Most participants were new nurses. The methodological quality was assessed as low to moderate and there were high risks of bias. In three of the five included studies, a statistically significant effect of onboarding practices and programs on new professionals' adjustment could be confirmed (Cohen's d 0.13-1.35). Structured and supported on-the-job training was shown to be the onboarding strategy with the strongest support to date. The certainty of the evidence was rated as low.

CONCLUSION

The results suggests that organizations should prioritize on-the-job training as a strategy to facilitate organizational socialization. For researchers, the results suggest that attention should be given to understanding how to best implement on-the-job training to ensure strong, broad, and lasting effects. Importantly, research of higher methodological quality investigating effects of different onboarding programs and practices is needed. Systematic review registration number: OSF Registries osf.io/awdx6/.

Nurses Transitioning to Primary Health Care in Australia: A Practice Improvement Initiative

Introduction

Current nursing programs provide little pre-registration information and clinical exposure to primary health care nursing practice. Newly graduated nurses and those transitioning to primary health care report disorientation and confusion. Limited knowledge about the ideal elements of a program to support transitioning nurses is an imperative to understand how best to support nurses during this period. The peak body for nurses in primary health care was funded to develop and implement a 1-year transition to practice improvement initiative for nurses in Australia about to be employed in or who are new to primary health care. This quality improvement evaluation study aimed to determine the impact of the transition program on participants' nursing knowledge, skills, and confidence, and their overall satisfaction with the program.

Methods

A mixed methods evaluation of the project utilized data from online pre- and post-participation surveys, mentor meetings, and field notes. Descriptive statistics and paired t-tests were employed for quantitative items. Free text and field notes were subject to broad thematic analysis. Findings from qualitative and quantitative data were triangulated.

Results

Ninety-three nurse participants and 62 mentors were recruited. There were statistically significant differences between mean summed post-completion and pre-completion self-assessment rating scores for knowledge, skills, and confidence. Program elements were well received. The orientation workshop, mentoring, and education activities were identified as most influential in supporting transition. The self-assessment framework was identified as least influential.

Conclusion

A 12-month transition program was effective in building the knowledge, skills, and confidence of participants to deliver comprehensive and effective nursing services.

Faculty perceptions of the impact of the COVID-19 pandemic on new graduate nurses' transition to practice: A qualitative study

BACKGROUND

The COVID-19 pandemic disrupted nursing education worldwide. Most studies have focused on how the pandemic affected students. With an alarming workforce shortage, a better understanding of the pandemic's impact on new nurses is vital to proactively develop strategies to promote success of the profession's newest members.

PURPOSE

This study explored faculty perceptions of the pandemic's impact on new nurses' practice preparedness and recommendations for promoting effective transition to practice.

METHODS

Using an exploratory-descriptive qualitative approach and convenience sampling, 116 nurse faculty from across North Carolina, United States responded to open-ended questions within an electronic survey. Data were analyzed with thematic analysis.

RESULTS

Four themes emerged: 1) Less Hands-On, 2) Transition-to-Practice Opportunities, 3) Key Role of Preceptors, and 4) Provide Additional Support.

CONCLUSIONS

Findings provide strategies clinical nurses and leaders can implement to meet the needs of new nurses entering professional practice during the ongoing pandemic. Due to less hands-on learning, pandemic graduates may benefit from extended time with a trained preceptor and opportunities to focus on clinical reasoning, managing multiple patients, effective communication, and safe skill performance. Upon entering the clinical environment, pandemic graduates' inexperience may increase the likelihood of transition shock, requiring multi-faceted approaches for providing support.

The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review

AIMS AND OBJECTIVES

This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and stress and enhance new graduate nurses' resilience during the transition from education to clinical practice.

BACKGROUND

Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown.

DESIGN

A scoping review of the current literature (with no date limit) using the PRISMA-ScR checklist for reporting scoping reviews was utilised.

METHOD

Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched.

RESULTS

This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students.

CONCLUSION

The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying.

RELEVANCE TO CLINICAL PRACTICE

Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.

Development of a Long-Term Care Nurse Residency Program

Nurses working in the long-term care (LTC) setting provide increasingly complex patient care, often without formal training on the specific needs of LTC patients, which can lead to burnout and high turnover rates. Nurse residency programs (NRPs) have been used effectively to orient novice RNs to their work setting, address transition-to-practice challenges, and promote retention, yet few LTC NRPs have been developed. The University of Utah Geriatric Education Consortium Geriatric Workforce Enhancement Program created an online LTC NRP to provide LTC nurses with the knowledge and skills to succeed in the LTC environment. RNs with <1 year of LTC experience were paired with experienced nurse mentors working within the same LTC facility. Synchronous and asynchronous curricular modules addressed leadership and communication, caring for older adult patients, quality improvement, and the LTC regulatory environment. A distance-based LTC NRP allows nurses flexibility in gaining gerontological nursing and leadership expertise that supports their professional goals. [Journal of Gerontological Nursing, 47(2), 37-43.].

Bridging the Gap: A Hospice Nurse Residency Program

There are few formal training opportunities that exist for RNs interested in the rapidly growing field of hospice and palliative care. To address this, the curriculum for a nurse residency program was developed and delivered to 12 nurses over 1 year. The nurse residents, as well as their clinical supervisors and interprofessional colleagues, were surveyed to obtain feedback on the overall program. Skill acquisition of the nurses was also assessed. The results indicate that the nurse residents had increased levels of confidence in caring for dying patients, communication with other clinicians, and delegation and management of treatment teams and families. According to supervisors and colleagues, strengths of the program included support for new nurses, integration of the interprofessional team, and solid preparation for new hospice nurses. These findings provide nursing educators and administrators with needed insight into the development and evaluation of an RN residency program in hospice and palliative care. [J Contin Educ Nurs. 2020;51(8):371-376.].

Assessment of public health core competencies in prelicensure baccalaureate nursing students

OBJECTIVE

The purpose of this study was to assess the use of the Public Health Foundation's (Public Health Foundation [PHF], ) Competency Assessment for Tier 1 Public Health Professionals to examine prelicensure baccalaureate nursing students' self-reported levels of competence in public health before and after completing community health nursing courses.

DESIGN

Prelicensure baccalaureate nursing students enrolled in community health nursing courses completed a pre and postcourse Competency Assessment for Tier 1 Public Health Professionals survey. The survey results were analyzed using nonparametric tests to determine whether there were significant differences in pre and postsurvey scores for the eight domains of public health core competencies, and for an overall competency score.

RESULTS

Significant differences were found in the pre and postaggregate mean scores for each of the eight domains of public health core competency, and the overall mean public health competency score. Chi-square testing of pre and postcourse competency found significant difference in the proportion of students who met criteria for self-reported competence in each of the eight domains and overall public health competence.

CONCLUSION

The Competency Assessment for Tier 1 Public Health Professionals can assist baccalaureate nursing faculty with assessing precourse learning needs, and postcourse evaluation of self-reported competence in public health.