A patient safety focused registered nurse transition to practice program

Competencies expected of undergraduate nursing students: A scoping review

AIM

Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work.

DATA SOURCES

We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar.

REVIEW METHODS

We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial.

RESULTS

Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development.

CONCLUSION

Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country.

IMPACT

These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

Newly graduated Nurses' experiences of the intervention graduate guidance nurses: A qualitative interview study

AIMS

Describing newly graduated nurses' experiences of the intervention graduate guidance nurses.

BACKGROUND

Newly graduated nurses need support to become established in the profession. The intervention was initiated to empower and support in the professional role.

METHODS

A qualitative case study conducted with semi-structured interviews, using a thematic content analysis.

RESULTS

One overarching theme "Organizational prerequisites, consisting of three themes occurred: "Activator" involved that the graduate guidance nurse was the activator creating a clear structure and the wards became more attractive workplaces. "Supportive nursing" meant that the graduate guidance nurse constituted an important support function which ensured patient safety. "Professional development" created the opportunity for professional growth.

CONCLUSION

Newly graduated nurses' experiences shows that the creation of an organizational structure enabled the graduate guidance nurses to be an important support and contributed to professional development.

IMPLICATIONS FOR NURSING MANAGEMENT

In healthcare organizations, strategic decisions, management support, and clear goals are important to create the organizational conditions to improve safer care. Support from experienced nurses is a large enabler in supporting newly graduated nurses developing in their profession. The results of the current study can be transferred to other similar healthcare organizations and can be supporting managers who plan to initiate support to newly graduated nurses.

Stepwise Interactive Situated Training Program for Young Nurses’ Safety Behavior and Interrupted Coping Behavior

Young nurses’ safety behavior and interrupted coping behavior affect patient safety. A stepped, interactive and situated training program should be evaluated to assist young nurses in improving themselves. This study aimed to evaluate the effect of the stepwise interactive situated training program on safety behavior and practice ability with respect to nursing interruptions for young nurses and its influencing factors. This was a quasi-experimental, one-group, self-control and pretest–post-test design study. Six hundred young nurses in two provinces were included. The participants underwent a stepwise interactive situated training program from March to August 2019. The program was delivered by designated head nurses and consisted of five themes: mobilization, theoretical training, operational training, specialized training and self-improvement. Five hundred and sixty-two young nurses completed this study. The safety behavior and the practice of nursing interruption were significantly higher after intervention than before. Professional titles, age and occupational time were the influence factors. The stepwise interactive situated training program was effective at improving young nurses’ safety behavior and interrupted coping behavior. Nurses with higher professional titles performed better with regard to the safety behavior and the practice of nursing interruption.

Experiences of Western Australian rural nursing graduates: A mixed method analysis

AIMS AND OBJECTIVES

To determine whether the current rural graduate programmes in Western Australia adequately support new graduate nurses transitioning into practice.

BACKGROUND

Graduate nurse's transition to employment is a time of significant change and challenge, often resulting in periods of transition shock. These challenges are magnified in rural areas where graduates have to relocate to commence their career with limited rural nursing experience. Graduate programmes were developed to smooth the transition for university trained bachelor's degree registered nurses into the workforce. Supportive graduate nursing programmes are essential for enabling transition to practice and reduce attrition rates.

DESIGN

Longitudinal convergent mixed method parallel design was informed by Duchscher's transition stage model.

METHOD

Thematic analysis was applied to all interviews. COREQ checklist was completed. Descriptive statistics and content analysis were used to analyse the survey responses.

RESULTS

New graduates cycled through both transition shock and honeymoon periods on commencement of employment, reporting high levels of satisfaction in simultaneity with signs of transition shock. Satisfaction dropped within 7 months indicating a transition crisis before an adjustment period occurred at the end of their graduate year. Limited resources were highlighted as obstacles to providing adequate support to rural graduate nurses.

CONCLUSION

The honeymoon stage of transition co-existed with transition shock at the commencement of graduate programmes, which may obscure the need for continuing adequate support. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programmes. Graduate programmes need to be structured but flexible to allow for individual differences in graduates' and clinical contexts.

RELEVANCE TO CLINICAL PRACTICE

Structured but flexible graduate programmes allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their graduate year to assist and overcome the transition crisis stage. Education of nurses undertaking the preceptor role is required to deliver adequate support to graduate nurses and decrease transition shock.

A bridge over troubled water? - Exploring learning processes in a transition program with newly graduated nurses

Successful preparation of newly graduated nurses (NGN) is a critical concern for the healthcare sector. This study explores the learning processes enacted in a transition program with NGNs implemented in hospitals in western Sweden. Group interviews with NGNs and ward managers were conducted, with the data analyzed using qualitative thematic analysis. The following themes were identified as the learning processes secured through the program: Recognizing the NGNs' role as novice practitioners, Emphasizing newly graduated nurses as learners, and Progressing towards a comprehensive nursing role. To support these learning processes, the program should provide opportunies to consolidate and reconcile NGNs' experiences as novices in healthcare environments where effective performance is crucial. If NGNs are supported in these ways, the program can make salient contributions to develop the knowledge bases of their occupational expertise.

Nurse Preceptor Role in New Graduate Nurses' Transition to Practice

The transition to practice period is a challenging and demanding time for new graduate nurses. Leaving the structured environment of nursing school and entering professional practice can cause reality and transition shock for the new nurse resulting in unsafe patient care, as well as intention to leave their position or the profession. Successful transition to practice depends on the new nurse building confidence and gaining essential clinical reasoning abilities while orienting to their role. In critical care settings, patient care is more complex and fast-paced, which adds another dimension of overall stress to the new graduate. Structured orientation programs with trained preceptors have been found to be the most successful means of preparing new graduate nurses for clinical practice. Ensuring preceptors are provided with education related to the development of clinical reasoning is essential to successfully assist new nurses in their transition to practice. Safe and effective patient care, especially in the critical care unit, is dependent upon having nurses who are well prepared for their role through being provided guidance and support from trained preceptors.

Effective orientation programs for new graduate nurses: A systematic review

OBJECTIVE

To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.

METHOD

A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008-2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program.

RESULTS

A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization.

CONCLUSION

Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.

Transition support for new graduate nurses to rural and remote practice: A scoping review

BACKGROUND

New graduate nurses undertaking transition to practice encounter enormous challenges in their first year, and this is expounded in rural and remote locations. In rural and remote settings where geographical isolation and inadequate resources impact health care delivery, there is a perceived shortage of support systems to assist new graduate nurses to transition smoothly, with reported negative effects for all staff and on recruitment and retention.

OBJECTIVES

To investigate what transition support was reported for new graduate nurses to function effectively in rural and remote settings.

DESIGN

A study protocol was developed using principles for scoping reviews that have been developed over the past fifteen years.

DATA SOURCES

CINAHL, Medline, Proquest, Embase, Informit, PubMed, and Science Direct were systematically searched according to a predetermined search strategy.

REVIEW METHODS

Search terms included New Graduate AND Rural OR Remote AND Education. Studies were selected according to an inclusion and exclusion criteria. Three reviewers were involved in independent screening of articles. The degree of agreement for an article to be included was based on a Kappa score calculation for inter-rater reliability.

RESULTS

Of the 662 articles searched, 13 met the inclusion criteria and their findings synthesised to form this review. Three overarching themes (and a number of subthemes) were identified within the context of rural and remote nursing workforce development, and included: new graduates' support needs, multifaceted support strategies and recruitment and retention strategies.

CONCLUSIONS

Challenges faced by new graduate nurses when transitioning to practice are exacerbated in most rural and remote settings due to resourcing, lack of structured support programs, lack of training for support staff to mentor and give feedback and this impacts on recruitment and retention as well. Structured, well supported transition programs that provide flexible support are urgently required in these settings.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice

AIMS

To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety.

BACKGROUND

New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care.

DESIGN

Qualitative descriptive approach using semi-structured interviews.

METHODS

Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1).

RESULTS

Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety.

CONCLUSION

Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses.

RELEVANCE TO PRACTICE

Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice

CONTEXT

  Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown.

OBJECTIVE

  To determine how newly credentialed ATs are oriented to their roles.

DESIGN

  Cross-sectional study.

SETTING

  Online survey.

PATIENTS OR OTHER PARTICIPANTS

  Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years).

DATA COLLECTION AND ANALYSIS

  The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results:  The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001).

CONCLUSIONS

  Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.

Ethical tensions: A qualitative systematic review of new graduate perceptions

Background:

New graduate transition into the workforce is challenging and can involve managing ethical tensions. Ethical tensions cause new graduates to doubt their capabilities due to their lack of experience. To support new graduates, we need to know what these ethical tensions are.

Objectives:

To explore the ethical tensions perceived to occur in practice for new graduate health professionals.

Research design:

This qualitative systematic review involved a search of five databases (Medline, EMBASE, AMED, CINAHL and Scopus) which resulted in the retrieval of 3554 papers. After the two-phased screening process, eight studies were identified that met the inclusion criteria and had rich data on the review question. Articles were read several times, critically appraised and analysed through thematic analysis.

Ethical considerations:

No ethical approval was required for the systematic review. The review was conducted following well-established reporting guidelines enabling transparency and rigour.

Findings:

Studies originated from Australia, United States, Iran and China. One study included speech pathologists and seven were with nurses. Four themes included the following: (1) enduring an unknown workplace culture that generates uncertainty without support for new graduates; (2) being vulnerable because of distress from bullying, exclusion and being a scapegoat; (3) constraining systems and institutional restrictions that cause dilemmas; and (4) experiencing disillusionment from lost ideals about ethical practice.

Discussion:

This review has brought to light the vulnerability of new graduates to negative workplace culture and collegial incivility. In addition, new graduates are subjected to ethical tensions created by institutional constraints which can create dilemmas and uncertainties through practice that does not align with what they anticipated.

Conclusion:

Understanding ethical tensions experienced by new graduates enables provision of informed support. There needs to be considerable cultural change for orientation and socialisation of new graduates to enable them to learn and manage ethical tensions.

Graduate-Assistant Athletic Trainers' Perceptions of Professional Socialization in the Collegiate Setting: Part I

CONTEXT

Many newly credentialed athletic trainers (ATs) pursue graduate assistantships, which allow them to gain experience while being supervised by an experienced AT. The graduate-assistant (GA) ATs' perception of their socialization process into the collegiate setting is unknown.

OBJECTIVE

To explore the professional socialization of GAs in the collegiate setting.

DESIGN

Qualitative study.

SETTING

Phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 6) participated.

DATA COLLECTION AND ANALYSIS

Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review.

RESULTS

Four themes emerged: (1) role identity, (2) initial entry into role, (3) maturation, and (4) success. Before beginning their role, participants envisioned the assistantship as a way to gain independent experience while being mentored. They perceived themselves as the primary care providers for their athletic teams. Those who were immediately immersed into clinical practice adapted to their role quickly despite experiencing stress initially. Participants felt that a formal orientation process and a policies and procedures manual would have alleviated some of the initial stress. The GAs matured as they practiced clinically and developed confidence as they gained experience. Personal attributes, experience, and peer and supervisor support contributed to perceived success as GAs. Factors that hindered perceived success were lack of confidence, an unsupportive environment, and long hours.

CONCLUSIONS

When looking for graduate assistantships, ATs should seek a position that allows them to practice independently and provides didactic educational opportunities while aligning with their athletic training philosophies.

Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

CONTEXT

Research is limited on the transition to practice of newly credentialed athletic trainers (ATs). Understanding this transition could provide insight to assist employers and professional programs in developing initiatives to enhance the transition.

OBJECTIVE

To explore newly credentialed ATs' experiences and feelings during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

Thirty-four ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 23.8 ± 2.1 years; work settings were collegiate, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Participants were interviewed via phone using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed through phenomenologic reduction, with data coded for common themes and subthemes. Credibility was established via member checks, peer review, and intercoder reliability.

RESULTS

The 3 themes that emerged from the data were (1) transition to practice preparation, (2) orientation, and (3) mentoring. Transition to practice was rarely discussed during professional preparation, but information on the organization and administration or capstone course (eg, insurance, documentation) assisted participants in their transition. Participants felt that preceptors influenced their transition by providing or hindering the number and quality of patient encounters. Participants from larger collegiate settings reported more formal orientation methods (eg, review policies, procedures manual), whereas those in secondary school, clinic/hospital, and smaller collegiate settings reported informal orientation methods (eg, independent review of policies and procedures, tours). Some participants were assigned a formal mentor, and others engaged in peer mentoring.

CONCLUSIONS

Employers could enhance the transition to practice by providing formal orientation and mentorship. Professional programs could prepare students for the transition by discussing how to find support and mentoring and by involving preceptors who provide students with opportunities to give patient care.

Dispositional mindfulness and employment status as predictors of resilience in third year nursing students: a quantitative study

Background

Nursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities.

Aim

This paper investigates the predictors of resilience, including dispositional mindfulness and employment status of third year nursing students from three Australian universities.

Design

Participants were 240 undergraduate, third year, nursing students. Participants completed a resilience measure (Connor–Davidson Resilience Scale, CD‐RISC), measures of dispositional mindfulness (Cognitive and Affective Mindfulness Scale Revised, CAMS‐R) and professional quality of life (The Professional Quality of Life Scale version 5, PROQOL5), such as compassion satisfaction, compassion fatigue and burnout.

Method

An observational quantitative successive independent samples survey design was employed. A stepwise linear regression was used to evaluate the extent to which predictive variables were related each to resilience.

Results

The predictive model explained 57% of the variance in resilience. Dispositional mindfulness subset acceptance made the strongest contribution, followed by the expectation of a graduate nurse transition programme acceptance, with dispositional mindfulness total score and employment greater than 20 hours per week making the smallest contribution. This was a resilient group of nursing students who rated high with dispositional mindfulness and exhibited hopeful and positive aspirations for obtaining a position in a competitive graduate nurse transition programme after graduation.