An exploration of graduate nurses' perceptions of their preparedness for practice after undertaking the final year of their bachelor of nursing degree in a university-based clinical school of nursing

Readiness for professional practice among health professions education graduates: a systematic review

Readiness to practice is the state of being prepared and capable of engaging in professional activities in a specific field. Graduates of healthcare professions require a diverse set of skills, knowledge and attitudes to meet the demands of complex healthcare settings. This systematic review provides a comprehensive analysis of readiness for professional practice among graduates of health professions education. It encompasses a wide range of articles published between 2013 and 2024, incorporating various health professions and utilizing a combination of quantitative, qualitative, and mixed methods designs. The review identified 93 studies from 32 diverse countries. The review revealed that factors influencing readiness to practice, include individual capabilities, the workplace context, and educational provision. It also explored strategies to enhance readiness to practice. The findings underscore the significance of addressing challenges such as lack of confidence, stress, communication, time management, job satisfaction, clinical experience, academic workload, teaching quality, mentorship and curriculum design. This comprehensive analysis serves as a valuable resource for healthcare educators, policymakers, and practitioners seeking to optimize the preparedness of graduates for the complexities of contemporary healthcare environments. Future studies should explore the interactions between readiness to practice stakeholders' perception of the educational curriculum, and the quality of support in the professional practice environment.

Factors related to readiness for practice among undergraduate nursing students: A systematic review

AIM

This systematic review identifies the factors and effective strategies related to nursing students' readiness for practice.

METHOD

A search was conducted from 2012 to 2022 in PubMed, CINAHL, SCOPUS, PsycInfo and EMBASE databases, using a combination of predetermined keywords. Four authors made the selection independently and the methodological quality was assessed using the RoBANS, Analytical cross-sectional studies Critical Appraisal Tool and MMAT tools. Information was extracted using a matrix and analyzed through the thematic synthesis approach.

RESULT

Studies (14,000) were identified from the search and 11 met the predetermined inclusion criteria. The main identified themes were personal characteristics, education-related factors, cognitive factors, psychological characteristics and social factors influencing readiness to practice. Some barriers also affect readiness for practice among undergraduate nursing students.

CONCLUSION

Multiple personal, educational and community factors interact in diverse ways to influences nursing students readiness to practice.

REGISTRATION

The protocol for the conduct of this study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020222337.

Graduate nurses' capability upon entering the workforce: An integrative review

OBJECTIVES

To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates.

DESIGN

Integrative review.

DATA SOURCES

Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases.

REVIEW METHODS

Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis.

RESULTS

Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge (knowing) along with practical knowledge (doing). They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates.

CONCLUSIONS

A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

An integrative review of simulation, senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.

AIM

The aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.

BACKGROUND

Readiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.

METHOD

An integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.

RESULTS

Themes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.

CONCLUSION

Although the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.

Approaches used to enhance transition and retention for newly qualified nurses (NQNS): A rapid evidence assessment

AIM

To undertake a rapid evidence assessment of approaches used to enhance nurse transition and retention for newly qualified nurses and to evaluate the strength of the evidence for specific approaches to nurse transition and retention.

DESIGN

A rapid evidence assessment was undertaken. Electronic databases were searched, and the full texts of relevant papers were retrieved. Studies were appraised using relevant Critical Appraisal Skills Programme and Mixed Methods Assessment Tools and a single descriptor of quality: high; medium; or low was assigned to each output. Given the disparity in methods, the lack of randomised trials, results could not be combined; therefore, a descriptive approach was used to synthesise and present the data.

DATA SOURCES

The search was undertaken using: specific database searching; and secondary searching of relevant websites. Electronic databases (CINAHL complete, Academic search premier, Open Grey, ERIC* (Education), Web of Science-Social Science Citation Index and PubMed) were searched during February 2018.

RESULTS

Orientation and creating supportive environments were frequently reported as being effective in enhancing transition across a range of studies. A range of methods: quasi-experimental, survey and qualitative were used. Generally, the quality of most studies was poor.

CONCLUSIONS

Despite decades of research into the experiences of newly qualified nurses and development of schemes and frameworks to support them during this period, there is little substantive or robust evidence in terms of impact on retention. Further research into the longer-term retention of newly qualified nurses is recommended. Longitudinal studies would be beneficial in assessing the efficacy of approaches to enhancing retention.

Hemşirelik Son Sınıf Öğrencilerinin Mesleğe Hazir Bulunuşluklari Ve Etkileyen Faktörler: Doğu Karadeniz Bölgesi Örneği

Objectives: This study aims to examine the readiness of final year nursing students for their profession and the affecting factors.Method: The population of this descriptive study consisted of 440 final year nursing students at five different universities in Turkey's Eastern Black Sea Region. The sample consisted of 313 students. The data were gathered between January and February, 2015. The researchers prepared and used a questionnaire form in line with the literature to collect the data. The data were evaluated with SPSS 20.0 statistical software using descriptive statistics, the chi-square test and binary logistic regression.Results: Of the students, 56.2% said that they were ready for the profession. There were statistically significant correlations between students' readiness for the profession and their having selected the profession willingly, being happy to have selected the profession, feeling safe in the profession, self-efficacy for the profession, feeling anxiety concerning working life and thoughts about nursing (p<0.05). There is statistically significant correlation between students' readiness for nursing and their finding practical training adequate in undergraduate study (p<0.05).Conclusion: This study found that half of the students were ready for the profession. Their having selected the profession willingly, being happy to have selected the profession, self-efficacy for the profession and feeling anxiety concerning working life were predictor variables for readiness.

Senior Nursing Students' Perceptions of Their Readiness for Practice Prior to Final Year Internship: Part 2-A Qualitative Perspective

INTRODUCTION

Preparing nursing students for their role as future registered nurses is an essential and complex endeavor. It is a responsibility that is shared between academic and clinical health care organizations. Arguably, the prevailing economic climate places additional pressures on the fiscal and manpower aspects of health care management. Maintaining a quality practice learning environment for students against this backdrop has become increasingly challenging. Indeed, students themselves have raised these concerns. The authors sought to explore these concerns further with the students, and this article will present the qualitative findings of a study exploring final-year students' perceptions of their readiness for practice in a school of nursing in the Republic of Ireland.

METHODS

Two open-ended questions were included on a quantitative survey, which sought to ascertain students' self-reported level of readiness for oral medication administration. A convenience sample of 24 final-year students undertaking a 4-year BSc (honors) in general nursing program was involved. Content analysis was employed to explore and elicit the key components of participants' written responses to the open-ended questions.

RESULTS

Participants highlighted the constraints that they have witnessed in some practice areas, the consequent impact on the availability of particular learning opportunities, and their level of preparedness for practice. Three key areas of concern emerged including medication management, patient caseload management, and communication. A recurring issue centered on the delegation of the more fundamental nursing tasks to students by qualified nurses, to the detriment of students' experience of the more complex aspects of holistic patient care. This proved quite exasperating for these participants.

CONCLUSION

This study demonstrates that final-year undergraduate nursing students in a school in the Republic of Ireland are concerned about their readiness for practice. Specific areas of concern for students relate to their capacity to develop competence for registered practice. These findings provide both a timely reminder and opportunity for those charged with the responsibility of preparing nurses for registration, in both clinical and academic settings, to raise awareness of factors that can impact on the student experience and learning in practice. They highlight the importance of a collaborative approach to addressing the issues that emerged, if competence and patient safety are to be safeguarded and maintained in the future.

The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study

BACKGROUND

Due to projected nurse shortages, it is necessary that undergraduate programs optimise work readiness outcomes in new graduate nurses. Research that quantitatively evaluates characteristics of clinical nursing programs that predict increased work readiness is required.

OBJECTIVES

To explore the relationship between the undergraduate clinical learning environment and nurse perceptions of work readiness prior to and following, commencement as a new graduate nurse.

DESIGN

A pre-post follow-up study. Undergraduates were surveyed at the end of their Bachelor's degree (baseline) and at 8-10 weeks after commencement as a graduate nurse (Time 1).

SETTING

A multi-site, metropolitan private hospital in Victoria, Australia.

PARTICIPANTS

Nursing graduates who completed a university fellowship program (n = 26), or were undertaking their graduate year and had completed placement blocks within (n = 18) or outside (n = 31) the healthcare organisation.

METHODS

Participants self-completed the Clinical Learning Environment Inventory (CLEI) and Work Readiness Scale for Graduate Nurses (WRS-GN) at baseline and Time 1. Multiple regression analyses were performed.

RESULTS

CLEI scores significantly predicted work readiness outcomes (all p-values<.05), accounting for 16-36% and 17-28% of the variance of WRS-GN scores at baseline and Time 1, respectively. After adjusting for clustering due to clinical placement groups, CLEI Individualisation (p = .023) and Valuing Nurses Work (p = .01) predicted improved Time 1 WRS-GN Organisational Acumen. CLEI Innovative and Adaptive Culture scores predicted poorer Time 1 Organisational Acumen (p = .001).

CONCLUSIONS

Learning environments that offered high levels of individualised attention and valued nurses' work appeared to facilitate post-graduation engagement and identification with nursing practice. However, highly innovative and adaptive education may detract from optimal work readiness. Findings revealed that while important, the clinical learning environment only accounted for a small-to-moderate degree of nursing graduates' work readiness. To facilitate robust evidence-based improvement of clinical nursing education, future research should attempt to empirically establish the value of additional facilitators of work readiness.

Blended learning via distance in pre-registration nursing education: A scoping review

Prior to the Covid-19 global pandemic, we reviewed literature and identified comprehensive evidence of the efficacy of blended learning for pre-registration nursing students who learn across distances and/or via satellite campuses. Following a methodological framework, a scoping literature review was undertaken. We searched six databases (EBSCOHOST (CINHAL plus; Education research Complete; Australia/New Zealand Reference Centre); Google Scholar; EMBASE (Ovid) [ERIC (Ovid); Medline (Ovid)]; PubMed: ProQuest Education Journals & ProQuest Nursing & Allied Health Source) for the period 2005-December 2015. Critical appraisal for critiquing qualitative and quantitative studies was undertaken, as was a thematic analysis. Twenty-eight articles were included for review, which reported nursing research (n = 23) and student experiences of blended learning in higher education (n = 5). Four key themes were identified in the literature: active learning, technological barriers, support, and communication. The results suggest that when delivered purposefully, blended learning can positively influence and impact on the achievements of students, especially when utilised to manage and support distance education. Further research is needed about satellite campuses with student nurses, to assist with the development of future educational practice.

Cross-cultural adaptation and psychometric testing of the Verbal and Social Interaction Questionnaire: A cross-sectional study among nursing students in China

AIMS AND OBJECTIVES

To develop and validate the Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students.

BACKGROUND

The development of caring interaction skills is particularly important for achieving better nursing student-patient interactions. Nursing students in China, as in most countries, have often failed to establish a caring interaction with their patients. There is a lack of instruments to explore the difficulties and problems in nursing student-patient interactions in China.

DESIGN

A descriptive, cross-sectional survey was carried out.

METHODS

Data for cross-cultural adaptation and psychometric testing purposes were collected between May 10, 2017 and November 11, 2017. Exploratory and confirmatory factor analyses were performed; pilot testing, content validity and reliability were assessed for the translated questionnaire. EQUATOR guidelines for observational studies (strengthening the reporting of observational studies in epidemiology) were applied.

RESULTS

716 nursing students from four universities in China completed the questionnaire. A pilot testing (n = 32) was conducted at a university hospital. The internal consistency reliability and the intra-class correlation coefficients were satisfactory. The overall content validity index was 0.95. Exploratory factor analysis resulted in a four-factor solution, explaining 61.26% of the variance, and the items had factor loadings ranging from 0.46-0.82. The final model's fit indexes were relatively acceptable. Overall, this instrument demonstrated sound psychometric properties.

CONCLUSION

The Chinese version of Verbal and Social Interaction Questionnaire for Nursing Students has a high level of reliability and acceptable content validity. However, some values in the construct validity assessment were lower than was hypothesised, suggesting a need for further model modification.

RELEVANCE TO CLINICAL PRACTICE

This easy-to-use instrument may help nursing educators, clinicians and managers in the assessment and development of students' interactional skills during their training or student-nurse transition period. Using the questionnaire could both provide the students with a greater understanding of caring interactions and help the nursing educators gain a better comprehension of the students' verbal, social and interactional skills.

A collaborative approach to simulation development

Background

Meeting employer expectations is a challenge for new nurse graduates and their nurse educators. Designing studies to collect specific data on hospital expectations and new nursing graduate deficiencies is needed.

Sample

Hospital-based educators and preceptors (n=13) participated in one of two focus groups, to identify problem areas. Senior nursing students (n=64) participated in simulations developed from data obtained in the sessions.

Methods

Audio-recorded focus groups were conducted with the goal to identify deficiencies in new graduate nurses. Recordings were transcribed and analysed using thematic analysis.

Results

Hospital employer expectation themes identified include attending to basic patient needs, organisational skills, anticipation of risks and consequences, higher order technical skills, communication and ownership/accountability. Two simulations for senior nursing students were developed to address identified deficiencies.

Conclusion

Developing meaningful simulations which address deficiencies prior to graduation, in collaboration with potential employers, has the potential to lower the cost of graduate nurse orientation, improve patient outcomes, provide a greater sense of readiness to the graduate nurse and ultimately meet the needs of both the student and employer.

The impact of undergraduate clinical teaching models on the perceptions of work-readiness among new graduate nurses: A cross sectional study

BACKGROUND

Clinical Placements are an essential component of bridging the gap between academic theory and nursing practice. There are multiple clinical models designed to ease the transition from student to professional, yet there has been little exploration of such models and their impact on graduates' perceptions of work-readiness.

OBJECTIVES

This cross sectional study examined perceptions of work-readiness of new graduate nurses who attended one of the following clinical teaching models: the University Fellowship Program (UFP), the Traditional Multi-facility Clinical Model (TMCPM), and the Mixed Program (MP).

METHODS

Three groups of first year graduate nurses (UFP, TMCPM, and MP) were compared using the Work-readiness Scale, a validated and reliable tool, which assessed nurses' perceptions of work-readiness in four domains: organizational acumen, personal work characteristics, social intelligence, and work competence. A multivariable Generalized Estimating Equations regression investigated socio-demographic and teaching-modelrelated factors associated with work-readiness.

RESULTS

Of 43 nurses approached, 28 completed the survey (65% response rate) of whom 6 were UFP attendants, 8 attended the TMCPM and 14 the MP. Those who had attended the UFP scored higher than the other two in all four domains; however, the crude between-group comparisons did not yield statistically significant results. Only after accounting for age, gender, teaching setting and prior work experience, the multivariable model showed that undertaking the UFP was likely to increase perceptions of work-readiness by 1.4 points (95% CI 0.11-2.69), P=0.03). The UFP was superior to the other two placement models.

CONCLUSION

The study suggests that the UFP may enhance graduate nurses' perceptions of work readiness.

Graduating nurses' self-efficacy in palliative care practice: An exploratory study

BACKGROUND

Educational institutions and the health care industry agree that graduates from professional programs need to be "work ready" and capable of delivering competent and confident nursing care. One measure of program success is the student's self-efficacy in meeting expected graduate capabilities. In this study student's self-efficacy is related to palliative care graduate capabilities.

AIM

To explore graduating Bachelor of Nursing Science (BNSc) students' self-efficacy in caring for palliative care patients.

DESIGN

A qualitative design using semi-structured face-to-face interviews.

SETTING

A regional Australian university.

PARTICIPANTS

A purposive sample of 10 students in their final semester of study in a Bachelor of Nursing Science degree program.

METHOD

Semi-structured face-to-face interviews were conducted. Interview questions were informed by published palliative care graduate capabilities. Interview data were transcribed verbatim and coded by capability. The coded data were then analysed to determine evidence of self-efficacy in caring for palliative care patients.

RESULTS

All participants had experiences in caring for palliative care patients. However, the responses did not consistently reflect high degrees of self-efficacy in four documented palliative care graduate capabilities required to care for persons with a life-limiting illness.

CONCLUSIONS

The findings support others that have identified gaps between curriculum and health care industry requirements in terms of students' beliefs about their empowerment to deliver nursing care as graduates. Education interventions and approaches to program evaluation require further development to better support students' growth of self-efficacy in undertaking their graduate roles.

Newly graduated nurses' empowerment regarding professional competence and other work-related factors

Background

Although both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses’ professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors.

Methods

A descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses’ self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman’s correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach’s alpha coefficient was used to estimate the internal consistency.

Results

Newly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses’ empowerment.

Conclusions

New graduates need support and career opportunities. In the future, nurses’ further education and nurse managers’ resources for supporting and empowering nurses should respond to the newly graduated nurses’ requisites for attractive and meaningful work.

Registered nurses' perceptions of new nursing graduates' clinical competence: A systematic integrative review

Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners.