The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety: An Integrative Review

An Analysis of Orientation and Preceptorship Influence on Nurse Job Satisfaction Across Two States

A large public nursing data set was used to determine whether orientation and/or preceptor programs impact job satisfaction among registered nurses in Maine and Massachusetts. There was no association between orientation and preceptor programs and satisfaction, nor evidence that new nurse status modified the relationship. There is a need for evaluation of orientation and preceptor programs' structure and effectiveness, and innovation is needed in promoting job satisfaction, thereby increasing nurse retention.

Nurse manager support of graduate nurse development of work readiness: An integrative review

AIM

To systematically review relevant literature to identify how Nurse Managers support graduate nurse work readiness.

BACKGROUND

Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment.

DESIGN

A five-step, systematic integrative review reported in accordance with the PRISMA 2020 Checklist.

METHODS

The steps of the review method included (1) problem identification, (2) literature search, (3) data evaluation and quality appraisal, (4) data extraction and analysis and (5) presentation. Analysis used the Framework method and was guided by theory of graduate nurse work readiness and the Theoretical Domains Framework.

DATA SOURCES

MEDLINE COMPLETE, Cumulative Index to Nursing and Allied Health (CINAHL) Complete, ERIC and PSYCINFO searched in December 2020.

RESULTS

Studies eligible for inclusion (N = 40) represented research from 15 countries; most (67.5%, n = 27) used a qualitative design, 22.5% (n = 9) were quantitative and 10% (n = 4) used mixed methods. Three themes related to the social constructs and local area work environments influenced by nurse managers emerged: supporting people, supportive environment and supporting learning.

CONCLUSION

The review identified a lack of robust evidence about the effectiveness of specific nurse manager-led strategies to support development of graduate work readiness. However, the findings provide a framework to guide nurse managers in supporting graduate nurses and provide a foundation for further research about nurse manager roles in developing graduate work readiness.

IMPLICATIONS FOR THE PROFESSION OR PATIENT CARE

Previous research has described poor transition of graduate nurses as responsible for increased workplace errors, decreased job satisfaction and high rates of attrition. Exploring the role of nurse managers in graduate nurse transition is essential to ensure quality patient care and a sustainable workforce.

IMPACT

What Problem Did the Study Address? Graduate nurses face many difficulties when transitioning from student to qualified nurse. Nurse managers establish workplace culture through leadership styles, yet little is known about how they can best support graduate nurses to transition to professional practice in the acute hospital environment. What Were the Main Findings? High rates of attrition are attributed to poor support during the initial transition phase of graduate nurses. Nurse managers can impact transition by providing a supportive environment, support learning and by providing a team of supportive people. Where and on whom will the research have an impact? The research will have an impact on graduate nurses and nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution (integrative review exploring existing literature). This integrative review was registered with PROSPERO (CRD42021213142).

Managing the Current Workforce: Status of New Graduate Nurse Well-being and Clinical Development 2018-2021

A structured transition to practice (TTP) program is beneficial to the professional success and retention of new graduate nurses (NGNs). The COVID-19 pandemic impacted clinical preparation and the TTP experience of NGNs. Data from the Versant National Database between 2018 and 2021 were analyzed to determine the current state of NGN well-being and clinical development. Key findings from the analysis indicate that NGNs that are a part of a comprehensive TTP program remain highly committed to their organization, have increased satisfaction working with their colleagues, and indicate low intent to leave their position. However, there are opportunities to address individual rewards and recognition, clinical assignments, morale, feelings of belongingness, and well-being. These findings further support the importance of a nurse residency program as part of an overall workforce strategy and that individual, programmatic, and practice environment outcomes must be longitudinally measured and analyzed to be able to make necessary evidence-based changes to meet the future needs of NGNs and the profession.

Associations Between the COVID-19 Pandemic and New Nurses' Transition to Practice Outcomes: A Multi-site, Longitudinal Study

Background

The transition between nursing school and nursing practice has been well studied and recognized as a turbulent time for new nurses. Existing literature suggests that transition to practice (TTP) programs can successfully support new nurses through this challenging period. However, TTP program outcomes have not been studied related to the COVID-19 pandemic, which altered TTP experiences for many new nurses by limiting their access to clinical sites for hands-on patient care experience and shifting delivery of nursing education and TTP programs from in-person to virtual environments.

Purpose

The purpose of this study was to analyze the associations between TTP outcomes and the COVID-19 pandemic.

Methods

This was a retrospective correlational, longitudinal study using secondary analysis of Vizient /AACN Nurse Residency Program survey data from the Casey-Fink Graduate Nurse Experience Survey and the Nurse Resident Progression Survey. Self-reported data from new nurses in Southeast Texas who participated in a standardized TTP program before the COVID-19 pandemic (2017-2019) were compared with self-reported data from nurses who participated in the TTP program during the pandemic (2020 and 2021).

Results

A total of 2,673 nurses participated in this study. When adjusting for demographic composition of the cohorts, statistically significant differences (p < .05) were identified in the advocacy, patient safety, and commitment outcomes with a decline in change scores from baseline to 12 months in the COVID-19 pandemic cohort compared to the pre-COVID-19 pandemic cohort.

Conclusion

Our findings provide new information on the impact of the COVID-19 pandemic on new nurses' participating in a standardized TTP program. The results indicate that patient safety and commitment to staying employed in the organization and the nursing profession should be priority improvement areas for employers and TTP program staff as they work to support new nurses' TTP in a pandemic.

The Experience of Patient Safety Error for Nursing Students in COVID-19: Focusing on King's Conceptual System Theory

Some nursing students experience errors related to patient safety, such as falls, medication administration errors, and patient identification errors during clinical practice. However, only a few nursing students report errors during clinical practice. Accordingly, the present study aimed to investigate patient safety errors that nursing students experience during clinical practice in the context of the COVID-19 pandemic. This study conducted in-depth interviews with 14 candidates for graduation from the Department of Nursing at a university in South Korea. In addition, after transcribing the collected data, a directed content analysis for the data based on King's interacting system theory was performed. As a result, four core categories were identified: (i) nursing students' perception of patient safety error occurrence, (ii) interaction between nursing students and others, (iii) interaction between nursing students and organizations, and (iv) nursing students' training needs related to patient safety errors. Consequently, this study identified the patient safety error-related experiences of nursing students during clinical practice during the COVID-19 pandemic. The results suggest that in the future, nursing education institutions must establish a system for nursing students to report patient safety errors during clinical practice for patient safety education and develop practical and targeted education strategies in cooperation with practice training hospitals.

New graduate registered nurses' professional competence and the impact of preceptors' education intervention: a quasi-experimental longitudinal intervention study

AIMS AND OBJECTIVES

The aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses' professional competence development after preceptors' participation in an education intervention.

BACKGROUND

New graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses' competence, and preceptors and preceptorship could also have significant influence on their competence development.

DESIGN

A quasi-experimental longitudinal intervention study.

METHODS

The data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees' orientation, particularly from new graduates' point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates' self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist.

RESULTS

The education intervention aimed at preceptors did not have impact on the intervention group NGRNs' competence development. There were no statistically significant differences between the groups and effect size remained small.

CONCLUSIONS

The preceptors' education intervention was not effective enough to develop new graduates' professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses' competence development during their early career. Preceptors' education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments.

TRIAL REGISTRATION

Retrospectively registered.

Transition to Practice Programs in Nursing: A Rapid Review

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

Nursing students: the use of digital social network to profile nurses

ABSTRACT Objectives: to analyze the profile of nursing students at a university in southern Brazil and verify the effectiveness of the use of social networks in students’ location and adherence. Methods: a quantitative, descriptive and exploratory study, carried out with 314 students through a questionnaire prepared on Google Forms, made available through digital social networks and e-mails. Results: students were women, without training in a technical/assistance nursing course, participants in projects and research groups, with a graduate degree. Furthermore, more than 75% obtained their first job within six months after graduation, more than 80% worked in healthcare, with public employment, workload of up to 40 hours a week, income between four and ten minimum wages, and 92% indicated that they were satisfied and/or very satisfied with the course. Conclusions: the strategic use of social networks enabled greater adherence by the target audience and nursing students’ profile design.

Nurse Leaders' Assumptions and Attitudes Toward Residency Programs for New Graduate Nurses

The Future of Nursing Report from 2010 offered key recommendations for the practice of nursing, including the need for nurse residency programs for all new graduate nurses. Although numerous articles can be found about the programs themselves, finding information about the support of nurse leaders for such programs is more challenging. In the spring of 2019, a small group of invited nurse leaders from across the United States met during a "Think Tank." The purpose of this gathering was to discuss a policy brief offered by the American Academy of Nursing requiring all new graduate registered nurses to participate in a nurse residency program as part of their transition into practice. To determine nurse leaders' assumptions and attitudes toward nurse residency programs, the think tank planners conducted a national survey. Over 500 members of the American Organization for Nursing Leadership participated in this survey. In this article, the authors offer that nurse leaders are supportive of residency programs for new graduate nurses although some are still struggling with demonstrating the value proposition. In addition, nurse leaders are not in support of a national mandate.

The Nursing Professional Development Role in Fostering Professional Development, Leadership, and Academic Progression for New Graduate Registered Nurses

As the new graduate nurse transitions from academia to practice, they commit to lifelong learning to enhance their professional and personal growth. This article provides a comparison between bachelor of science in nursing and associate degree nursing nurses who participated in a multisite national nurse residency program between 2015 and 2019 in areas of professional development, leadership, and academic progression during their initial 3 years of practice. It also provides nursing professional development practitioners with strategies from two national experts to support new graduate nurses during early practice.

Evaluation of the Allied Health Rural Generalist Program 2017-2019

OBJECTIVE

To evaluate the development and implementation of the Allied Health Rural Generalist Program, a two-level online post-graduate education program, which includes Level 1, an entry-level non-award pathway program, and Level 2, a Graduate Diploma in Rural Generalist Practice.

DESIGN

A convergent mixed methodology evaluation in two overlapping stages: a process evaluation on quality and reach, together with a mixed method case study evaluation on benefits, of the program.

SETTING

Rural and remote Australia across ten sites and seven allied health professions: dietetics; occupational therapy; pharmacy; physiotherapy; podiatry; radiography; speech pathology.

PARTICIPANTS

Process evaluation included 91 participants enrolled in all or part of the Rural Generalist Program. Case study evaluation included 50 managers, supervisors and Rural Generalist Program participants from the ten study sites.

INTERVENTIONS

The Allied Health Rural Generalist Program.

MAIN OUTCOME MEASURES

Process evaluation data were derived from enrolment data and education evaluation online surveys. Case study data were gathered via online surveys and semi-structured interviews. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated to identify consistency, expansion or discordance across the data.

RESULTS

The Rural Generalist Program was viewed as an effective education program that provided benefits for Rural Generalist Program participants, employing organisations and consumers. Key improvements recommended included increasing profession-specific and context-specific content, ensuring Rural Generalist Program alignment with clinical and project requirements, strengthening support mechanisms within employing organisations and ensuring benefits can be sustained in the long term.

CONCLUSION

The Rural Generalist Program offers a promising strategy for building a fit-for-purpose rural and remote allied health workforce.

Undergraduate nursing students' perceptions of the current content and pedagogical approaches used in PIVC education. A qualitative, descriptive study

BACKGROUND

The peripheral intravenous catheter (PIVC) is the most frequently used invasive medical device. PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, delays in treatment, increased health care costs and even death. Undergraduate nurses assess and manage PIVCs as part of their clinical learning. To date, no study has explored undergraduate nurses' perceptions of the education they receive about PIVCs.

AIM

We sought to critically explore the current state of education regarding PIVCs from the perspectives of undergraduate nurses.

METHODS

This qualitative study involved semi-structured interviews with third-year undergraduate nurses. Data were collected across two sites in Queensland, Australia. Fourteen face-to-face interviews were conducted and a modified 5-step qualitative content analysis was used to analyze the data.

FINDINGS

We identified three key domains relating to participants' experiences of PIVC education: 1) Universities provide foundational knowledge about PIVC assessment, management and removal; 2) Clinical practice consolidates and drives undergraduate nurses' knowledge, skills and confidence about PIVCs; and 3) inconsistencies in clinical practice and between individual clinicians impedes learning and knowledge translation about PIVCs.

CONCLUSION

Nursing students benefit from theoretical content delivered in the university setting. Practical application of theory and skill development whilst on clinical placement is variable. The current undergraduate curriculum, related to management of patients with a PIVC, is disjointed and inconsistent and this inconsistency may negatively impact patient safety.

Innovation in Nurse Residency: Blazing a Trail With Online Technology

To prepare new graduate nurses for the work of the future, the Iowa Action Coalition identified implementation of nurse residency as a top priority. A taskforce of Iowa nurse leaders developed a turn-key program for all sizes and types of health care organizations, available as all online and blended options. Implementation provided statistically significant outcomes similar to traditional programs. Innovation continues to drive the program with transition to an RN residency apprenticeship. This work is a testament to how innovation can be used to prepare our nursing workforce for the future, foster collaboration through partnerships, and advance nursing research.

Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse-sensitive outcomes.

OBJECTIVES

To explore the relationship between use of contract nurses and two key nurse-sensitive outcomes, HAPIs and falls.

RESEARCH DESIGN

This was a cross-sectional study of unit-level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters.

SUBJECTS

605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses.

MEASURES

Prevalence and incidence of HAPIs and number of falls, adjusted by patient days.

RESULTS

For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls.

CONCLUSIONS

Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels.

CLINICAL RELEVANCE

Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.

New Graduate Nurses' Perceptions of Patient Safety: Describing and Comparing Responses With Experienced Nurses

BACKGROUND

A significant proportion of the acute health system workforce is composed of new graduate nurses, yet there is a limited understanding of patient safety perceptions among new graduate nurses and how they compare with nurses who have more experience.

METHOD

This study used a descriptive approach to complete secondary analysis on two sources of data containing new graduate nurses' (n = 1,613) and experienced nurses' (n = 64,906) responses to the Hospital Survey on Patient Safety Culture.

RESULTS

New graduate nurses had a more positive perception of safety culture than more experienced nurses. The greatest differences were observed in perceptions of how nurse managers respond to mistakes. Similarities in perceptions were observed on items associated with communication.

CONCLUSION

Educational systems and transitional programs must prepare new graduate nurses for patient care. There is an opportunity for academic and practice partners to collaborate on programs that facilitate the transition of new graduate nurses to the workforce. [J Contin Educ Nurs. 2020;51(7):309-315.].

Profile of nursing graduates: competencies and professional insertion

OBJECTIVE

evaluate the profile of the graduates of Nursing a public college from the perception of skills developed during graduation and the process of professional insertion.

METHOD

quantitative, exploratory and descriptive study. The sample was composed of 216 graduates. The data was collected by a validated questionnaire and sent to a population of 470 egresses via electronic mail. For the analysis of the data, frequencies, mean and standard deviation were applied and, for the correlation, the chi-square test.

RESULTS

the majority of the participants were female (88%) and the mean age was 29.62 years. The majority (65%) had an employment relationship, 14% worked in a single institution and 48% started working six months after graduation. Regarding the form of work, 56% work in care, with an average of 4.5 minimum wages and a weekly workload between 37 and 44 hours. The majority reported competence acquisition to practice the profession, assisting the patient in his integrality with ethics and applying technical and scientific concepts in care.

CONCLUSION

the study made it possible to describe the singularities of nurses' education, their insertion in the world of work and the impact on the educational institution, as well as the presentation of specific competences from the perspective of the graduates themselves.

Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review

New graduate nurse practitioner (NP) postgraduate support programs and interventions have proliferated, sparking controversy. The Institute of Medicine/National Academy of Medicine recommends residency programs for new graduate NPs; however, the NP community debates whether new graduate NPs need additional training and whether such training compromises patient access to care. This systematic review aimed to synthesize evidence regarding the effectiveness of interventions and strategies to promote the professional transition of new graduate NPs. Interventions identified in the current literature included fellowship programs and a webinar. Strategies included mentorship, experiential learning, interprofessional training, and professional socialization. The studies reviewed primarily evaluated NPs' perceptions of the interventions' effects on their professional transitions. The findings from this systematic review highlight challenges in evidencing postgraduate support programs. The small number of available studies underscores a critical problem for the NP community: additional evidence is needed to inform whether and how to support new graduate NPs as they transition to practice.

Leveraging the Librarian in a Nurse Residency Program

Hospitals are increasingly implementing Nurse Residency Programs (NRPs), but medical librarians are often left out of their institution's respective programs. Librarians possess a unique, knowledge-based skill set that is a natural fit for the content and goals of a NRP and should be more frequently considered and used by such programs. This article identifies and explores several roles for librarians in NRPs and discusses the impact and results of including librarians.