Mentoring to retain newly hired nurses

New graduate nurses' readiness for practice, transition and integration into the workplace: A longitudinal study with mixed methods research

AIM

To examine the readiness of new graduate nurses for practice and evaluate factors influencing their transition into the workplace.

BACKGROUND

This is new research in Bahrain. Understanding readiness for practice is important during a time when there is a national initiative to promote nursing as a career among the indigenous Bahraini population. The worldwide nursing shortages and aging workforce require new and innovative recruitment and retention measures. There is change, increased demand and complexity, in nursing and healthcare needs with accompanying healthcare specialization. In such a health care environment, the transitioning and readiness of newly qualified nurses is an increasing challenge.

DESIGN

A longitudinal design, with a triangulated, mixed methods, research approach was used.

METHODS

The study population consisted of 50 newly graduated nurses. Data were collected over one year through self-administered questionnaires, reflective diaries and focus groups. Quantitative data were analysed using SPSS and qualitative data using thematic analysis with adherence to GRAMMS reporting guidelines.

RESULTS

In Bahrain, there are actions to recruit young Arabic students to nursing including schools and community presentations by trained nurse ambassadors, social media activities and career exhibitions, however there is a lack of objective information on the perspective of cohorts of nurses who have successfully completed graduate nursing registration programmes and transitioned into practice. International literature suggests that the transition of newly graduated nurses can be stressful and challenging. On entry to practice, the respondents positively perceived their characteristics and attributes; however, their confidence was affected by challenges in the workplace. The transitioning of the new graduate nurses was affected by the availability of support and leadership, induction programmes and the new complex work environment.

CONCLUSION

Understanding work readiness and the emotional needs of new graduate nurses, accompanied by improved support, will enhance the transition of newly qualified nurses into the workplace and reduce attrition.

STUDY REGISTRATION

KHUH/Research/No.279/2019.

Supporting Role Knowledge and Role Transition in Neonatal APRN Students

Advanced practice registered nurses (APRNs) play a critical role in alleviating provider shortages and expanding access to health care services for medically underserved populations. To meet these shortages, the APRN workforce is growing faster than the average for all occupations. This creates a critical need for effective transitioning from the role of student to APRN provider. Unfortunately, transitioning to the APRN role is not seamless and role confusion or challenges in role exposition can contribute to job stress and even role exodus. A recent quality improvement project supported student understanding of APRN roles and anticipation of role transition challenges for neonatal students preparing for roles as nurse practitioner and clinical nurse specialist. This strategy has the potential to contribute to successful role transition of neonatal nurse practitioner and neonatal clinical nurse specialist students.

Scaling up pediatric nurse specialist education in Ghana - a longitudinal, mixed methods evaluation

Background

Inadequate health human resources is a key challenge to advancing child survival in Ghana. Nurses are an essential human resource to target because they represent the largest portion of the health workforce. Building on lessons learned from our pilot pediatric nurse training project and World Health Organization guidelines for transforming and scaling up health professional education, this project aimed to; train 500 pediatric nurse specialists through a one-year training program; develop and integrate a critical mass of pediatric nursing faculty and establish a national standardized pediatric nursing curriculum. This study aimed to evaluate the effectiveness of a national pediatric nurse training program in Ghana at the end of 4 years, including eight cohorts with 330 graduates.

Methods

This was a mixed-method evaluation with surveys, focus groups and a pre-test/post-test design. Before and after surveys were used to measure knowledge and confidence at baseline and graduation. Objective Structured Clinical Examinations (OSCE) were used to measure clinical skills at baseline, graduation, and 14 months follow-up. At the end of every module, surveys were used to measure students’ satisfaction. Focus groups at graduation qualitatively measured program outcomes. Repeat focus groups and surveys at 14 months after graduation captured the graduates’ career progress, experiences reintegrating into the health system and long-term program outcomes.

Results

Overall, the graduates completed the program with significantly increased knowledge, confidence, and clinical skills. They also had increased job satisfaction and were able to apply what they learned to their jobs, including leadership skills and gender-sensitive care. Data from 14-month follow-up OSCEs showed that all graduates remained competent in communication, physical assessment, and emergency care, although some obtained a lower mark compared to their performance at graduation. This finding is linked with the observation that the amount of mentorship, support from leadership and equipment that the graduates accessed from their respective facilities varied.

Conclusions

Mixed-methods evaluations demonstrated significant increases in knowledge confidence and skills by completing the program and maintenance of skills more than 1 year after graduation. Findings have implications for those working on the design, implementation, and evaluation of nursing education interventions in low- and middle-income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00550-1.

Alternative Approaches to Mentoring

TOPIC

Various approaches facilitate mentoring for critical care nurses.

CLINICAL RELEVANCE

Mentoring is an important strategy to help recruit, retain, and develop nurses with critical care expertise. Mentoring benefits nurses at all career stages, from novice to expert. Effective mentoring programs benefit not only mentors and mentees but also organizations and patients by ensuring adequate numbers of nurses with critical care knowledge and skills.

PURPOSE

Mentoring programs require careful planning to ensure that the objectives of the program align with the needs of the target audience, and that adequate resources are available to support the mentor-mentee relationship. This article identifies opportunities for mentoring in critical care nursing and provides recommendations from the literature for developing an effective program.

CONTENT COVERED

Various objectives for mentoring programs are described, including supporting retention, providing clinical development, and planning succession. Program logistics are explored, such as selecting mentors, matching mentors with mentees, setting goals and expectations, and evaluating the program. In addition, the article identifies strategies for overcoming common barriers to mentoring, which include a lack of time and poor access to qualified mentors.

New graduate nurses' clinical safety knowledge by the numbers

AIM

To explore new graduate registered nurses' knowledge and attitudes concerning medical error and patient safety, during their first 6 months of professional practice.

BACKGROUND

New graduate registered nurses demonstrate basic skills and levels of performance due to limited exposure and experience in actual situations. There is a concern held for their clinical reasoning skills required to recognize patient deterioration, posing a threat to patient safety.

METHODS

An online questionnaire was used to survey new graduate registered nurses at three time points during graduate nurse programmes between August 2016 and February 2018.

RESULTS

A decrease in self-reported knowledge and attitudes regarding medical errors was noted over the three time points. These results indicate initial confidence in theoretical knowledge and attitudes upon completion of undergraduate education, and prior to commencing professional practice.

CONCLUSION

Results suggest that a theory practice gap persists with respect to medical error for transitioning new nurses.

IMPACT FOR NURSING MANAGEMENT

New nurses lack confidence around compromised patient safety situations and a knowledge gap around actions related to medical error. Nurse managers and educators should be made aware of this gap to implement strategies to decrease risk during novice nurse transition.

Making the Transition: A Critical Care Skills Program to Support Newly Hired Nurses

PURPOSE

This article describes the impact of a hands-on critical care skills day led by clinical nurse specialist (CNS) to enhance junior nurses' clinical skills. Program objectives included providing specialized skills training to meet the needs of high-acuity patient population and reviewing nurse-sensitive indicator-associated care bundles with the goal of increasing compliance.

DESCRIPTION OF THE PROJECT

An 8-hour program of lecture and hands-on skills was developed. Curriculum included nursing-sensitive indicators, sepsis management, complex tubes and drains, airway management, and emergency response. Clinical nurse specialists mentored senior nurses to colead program planning and execution. The program has been offered 9 times. Qualitative and quantitative data were collected on attendees.

OUTCOME

Quantitative data analysis showed that 89% of the assessed components were affected by the program. Medium effect was noted in defibrillator skills, retrieving items from code care, care of suicidal patient, and sepsis screening. Qualitative data based on attendee survey are also presented and analyzed. Decreases in indwelling catheter utilization on select units are discussed.

CONCLUSION

The CNS has the responsibility to ensure nursing practice is reflective of hospital policy and current evidence. This program demonstrates the impact of CNSs in staff education, mentorship, and competency assessment.

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.

The art of preceptorship. A qualitative study

In the clinical nursing practice preceptorship is a widespread method to improve patient care by assisting nurses in developing the right clinical skills. However, little is known about how preceptorship should be practiced to achieve a positive learning outcome. The aim of the study was to investigate how preceptorship can be used in clinical practice to create learning and facilitate competence development. A qualitative study guided by a hermeneutic phenomenological approach and inspired by ethnographic fieldwork included 28 participant observations and 58 interviews. Data were analysed according to Steinar Kvale's three interpretation contexts. The findings showed three themes: Being together: Preceptee and preceptor were physically present in the same room optimising the learning situation with focus on complexity, use of senses and patient safety. Doing together: Preceptee and preceptor performed nursing together to obtain skills focusing on independence, practical skills and communication. Getting along together: Preceptee and preceptor together focused on the patient, relation, comfort and managing how to keep the balance between a professional and a personal relation. Precepetorship is situated learning where knowledge and skills are generated through participation in clinical practice. In this way, nurses develop clinical judgement and independence.