Flying Start NHS™: easing the transition from student to registered health professional

What does the literature say about preceptorship and mentorship in radiography: A scoping review of the current research and identified knowledge gaps

OBJECTIVES

Effective transition into radiography practice for newly qualified radiographers (NQR's), radiographers returning to practice after career breaks, and internationally trained radiographers requires support inclusive of preceptorship and mentorship. The purpose of this scoping review is to evaluate the literature pertaining to preceptorship and mentorship support in radiography to identify knowledge gaps. This is timely in view of the health and care professions council (HCPC) recently published preceptorship guidance.

KEY FINDINGS

A scoping review methodology underpinned by Arksey and O'Malley framework was undertaken, which employed a systematic search using combined keywords and Medical Subject Heading terms (MeSH) related to preceptorship and mentorship, of electronic databases: CINAHL, Pubmed, Embase, Scopus and Google scholar. A predetermined inclusion and exclusion criteria were used to screen by three independent reviewers, the titles, abstract and full text of articles using Covidence software (www.covidence.org). 10 articles in the English language were selected for the final review. 1574 articles were retrieved and assessed for eligibility, and 10 articles published between 2006 and 2022 met the inclusion criteria. Most of the research was conducted in the United Kingdom and only one study was published in Australia. The studies mainly focused on experiences of NQR, and experienced radiographers' perspectives on preceptorship and mentorship in diagnostic and radiotherapy radiography. It was established from the studies that there is variation in approaches to the transition process in terms of types of programmes, duration, and quality. Self-reported increase in confidence and competence was noted as a central objective, and barriers to implementation were identified to include lack of awareness and accessibility to available programmes, lack of clarity on aims and intended benefits, and lack of employer support pertaining to protected time.

CONCLUSION

The paucity of research renders current preceptorship and mentorship practices in radiography inadequate for effective transition of different radiography groups into their role. Further research is required to evaluate the models of preceptorship and mentorship, their impact and intended outcomes on radiography practice.

IMPLICATIONS FOR PRACTICE

The identification of knowledge gaps in this area can support employers and researchers in the development of effective models of preceptorships and mentorship which can be evaluated for implementation for specific radiography groups.

Construction of learning objectives and content for newly graduated nurses in tertiary teaching hospitals: A Delphi study

BACKGROUND

Transition education is a robust strategy to improve the core competency of newly graduated nurses and the quality of clinical nursing and ensure people's safety. Limited information about the learning objectives and educational content for newly graduated nurses in China was available.

OBJECTIVE

Construct the learning objectives and educational content for newly graduated nurses based on defined core competencies.

DESIGN

We used a literature review and the e-Delphi method to conduct this study.

SETTINGS

Ten tertiary teaching hospitals and six nursing schools in Zhejiang Province, China, were selected.

PARTICIPANTS

Experts (n = 21) were invited to the e-Delphi study.

METHODS

Based on seven competencies from the literature review and the research group discussions, we formed an initial set of objectives and specific educational content for newly graduated nurses. Subsequently, experts provided supportive and modification advice on the competencies, objectives, and specific content in the two Delphi rounds. The consensus percentage and the weight of each first-level, second-level, and third-level item were calculated.

RESULTS

Consensus was achieved on seven core competencies, 44 learning objectives, and 60 components of educational content. The positive coefficient of the two Delphi rounds was 100 %, the authority coefficient was 0.83 and 0.87, the proportion of experts who made suggestions was 71.40 %, the coefficient of variation (CV) was <0.25 (P < 0.05) except for two items and the Kendall coefficient (W) was 0.15-0.48 (P < 0.01).

CONCLUSION

The developed objectives and content framework provide a reference for implementing systematic and standardized education for newly graduated nurses.

What strategies facilitate & support the successful transition of newly qualified midwives into practice: An integrative literature review

OBJECTIVE

The aim of this review was to identify strategies that facilitate newly qualified midwives to transition successfully from midwifery student to confident, competent practitioner.

DESIGN

Integrative literature review.

DATA SOURCES

The following databases were accessed: CINAHL complete, Medline complete, APA PsycINFO, Cochrane Library, Joanna Briggs Institute (JBI), Scopus and Google Scholar.

REVIEW METHODS

A systematic search of key terms across all data sources for the period January 1990 to September 2021 identified 316 papers whose titles/abstracts were screened against our inclusion/exclusion criteria. Thirty-six full texts were screened for eligibility and three papers were identified through ancestral searching. Ten papers were included in our final review.

RESULTS

Mentorship or preceptorship for newly qualified midwives by experienced midwives appears to enhance experiences, either as a standalone strategy, or component of structured programs of transition support. Supernumerary time, designated study days and planned rotations are also valued, particularly when rotating through clinical areas. Smaller teams providing continuity of midwifery care, or organisations that fund mentorship programs appear more able to facilitate support. Mechanisms of online support and learning may also enhance early transition but similarly, require organisational investment to aid success. Whilst most programs were described as helpful none of the studies used validated measures to assess this.

CONCLUSION

Whilst elements of tailored support programs and mentoring/preceptorship from experienced colleagues appear to offer valuable support to transitioning practitioners, it is important to note that the structure of maternity care appears fundamental to the success of many of these strategies. Consequently, maternity care reform which focuses on the adoption of sustainable models of midwifery continuity, alongside urgent investment in midwives, are likely the most promising, over-arching strategies required to support student to midwife transition.

Stress and coping experience in Nurse Residency Programs for new graduate nurses: A qualitative meta-synthesis

Objectives

To determine the stress experience and coping styles of new nurses during Nurse Residency Programs (NRPs) by identifying, appraising, and synthesizing data from the qualitative studies.

Design

A systematic review and meta-synthesis of qualitative studies.

Review methods

Eleven databases were systematically searched for relevant publications in March 2022. All qualitative and mixed-method studies in English and Chinese that explored the stress and coping experience during NRPs of new graduate nurses were included. The qualitative meta-synthesis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two independent reviewers selected the studies and assessed the quality of each study. Meta-synthesis was performed to integrate the results.

Results

A total of 13 studies revealed 13 sub-themes and three descriptive themes: multi-dimensional stressors, somatic and emotional responses, coping resources and coping methods.

Conclusion

New nurses faced a lot of physical and emotional stress during NRPs, which had a negative impact on their physical and mental health. NRPs are a critical period for the career growth of new nurses. Effective management strategies must be implemented to improve nurse capacity, meet their needs, improve self-efficacy, and build organizational support, as this can improve the quality of clinical nursing and keep the enthusiasm and stability of the nursing team.

Joining the workforce during the COVID-19 pandemic: views of Allied Health Profession students

In the United Kingdom, the onset of the COVID-19 pandemic placed great pressures on universities to ensure final year health care students completed their studies earlier than planned in order to join the National Health Service workforce. This study aimed to explore the anticipations and support needs of final year allied health profession students transitioning to practice during a pandemic. Final year university students across seven healthcare professions were asked to complete an online survey. Demographic data were analyzed by descriptive statistics and responses to open questions were explored using content analysis. Sixty participants completed the survey. Content analysis regarding students' anticipations, fears, and support needs identified the following themes: professional identity and growth; opportunities for improvement; preparedness for transition from university to the workplace, the workplace environment; COVID-19; support from lecturers; daily support within the workplace and innovative methods of support. Although the transition from student to practitioner continues to be a stressful period, only a minority of participants reported COVID-19 as an explicit stressor. However, as the effects of COVID-19 continue to evolve in the United Kingdom, universities and healthcare trusts must ensure adequate supports are in place for recent graduates navigating this transition during a healthcare crisis.

Development and implementation of a standardized training program for newly graduated mental health nurses: Process and preliminary outcomes

BACKGROUND

Training programs are crucial for newly graduated nurses transitioning from nursing school to independent clinical nursing careers. However, few studies have focused on the training of newly graduated mental health nurses.

OBJECTIVES

The aim of this study was to develop, implement, and preliminarily evaluate a standardized training program for newly graduated nurses entering psychiatric nursing.

DESIGN

The Delphi technique was adopted for program development, and a quasi-experimental design was employed for program implementation.

SETTINGS

Six mental health institutions were involved in the practice training, and among these, three university-affiliated psychiatric hospitals were the study sites for theoretical training.

PARTICIPANTS

A total of 180 newly graduated nurses hired by the six hospitals were involved and 154 finished the training program.

METHODS

The program was developed using the Delphi method based on the results of a literature review and semi-structured interview with clinical practitioners. Change in mental health nurses' core competencies before and after the program was compared during program implementation. Focus group interviews were employed to collect the opinions and influence of the standardized training program after the intervention, and content analysis was used to analyze it.

RESULTS

A two-round Delphi expert consultation was done, and 7 core competency elements and 37 training topics were designed for the standardized training program. The six-month training program consisted of two months for course training and four months of practical training, which were guided by a manual. Total CIRN scale score improved (142.29 ± 34.87 vs. 160.35 ± 32.46, P < 0.01) after receiving the program as did the scores for each dimension (P < 0.01). Participants gave positive feedback and suggested optimal training length and certification for the program.

CONCLUSIONS

The standardized training program focused on mental health nursing proved to be a viable method of novice nurse training and resulted in positive outcomes. The program length and its long-term effects deserve further exploration to determine the best practical training program for sustaining optimal development of mental health nursing.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences

AIMS AND OBJECTIVES

To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention.

BACKGROUND

Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay.

DESIGN

Qualitative approach using semi-structured telephone interviews.

METHODS

Self-selecting sample of nurses (n = 23) who participated 1-year (n = 12) and 2 years (n = 11) post-qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual.

RESULTS

Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing.

CONCLUSION

This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

'Doing it for real now' - The transition from healthcare assistant to newly qualified nurse: A qualitative study

BACKGROUND

There has been increasing international research and policy interest concerning the transition from student to newly qualified nurse (NQN). However, the influence of previous employment as a healthcare assistant (HCA) on students' experiences of this transition is comparatively under-researched.

AIMS AND OBJECTIVES

To explore the experiences of NQNs also employed as HCAs during their pre-registration education programme and how this prior and ongoing HCA experience influenced their transition experiences.

DESIGN

Qualitative research design using a descriptive method.

SETTING AND PARTICIPANTS

Former students (n = 14) of a unique four year, part-time, employer-sponsored pre-registration nursing programme, specifically designed for HCAs and delivered by supported open learning, located in different regions and nations of the United Kingdom who had qualified within the last two years.

METHODS

Telephone interviews, digitally recorded, transcribed verbatim and analysed using NVivo8.

RESULTS

Four themes described participants' experiences of transition: In at the deep end, Changing identities, Coming together and Scaffolding. Findings confirm existing literature that all NQNs appear to experience a similar overarching experience of transition, including those with prior HCA experience. However, familiarity with people, place and routines afforded by this previous experience appeared to ease transition, particularly if the NQNs stayed in their previous HCA work location. However, managing the dual roles of being both HCA and student and adapting to their changing identities were frequently cited as particular challenges.

CONCLUSIONS

Van Gennep's Rites de Passage and Bridge's work on organisational change were combined to theoretically analyse participants' accounts of transition. This illustrated that transition is not always linear with clearly defined and bounded stages but can also be seen as a more undulating or organic process with curving, slanting and overlapping phases. NQNs can therefore simultaneously occupy more than once phase in their journey of transition. Implications for students, higher education and practice are highlighted.

Students' perceptions of their learning experiences: A repeat regional survey of healthcare students

BACKGROUND

Student experience is an international concern and recent research has focused on initiatives to improve students' learning experiences and ultimately reduce attrition levels.

OBJECTIVE

To determine similarities and differences between students' perceptions of their learning experiences between 2011 and 2015 in relation to campus-based learning, placement-based learning and personal circumstances.

DESIGN

A repeat online survey in 2011 and 2015; using a questionnaire developed from thematic analysis of narrative interviews with a subsample of the target population.

SETTINGS

Nine universities in the North West of England.

PARTICIPANTS

A total of 1080 students completed the survey in 2011 and 1983 students in 2015 from a target population of all students studying on commissioned pre-registration healthcare education programmes.

METHODS

An online survey was made available to all undergraduate students studying on Health Education funded programmes within the region and survey respondents were invited to give demographic information and rate their agreement to statements on four-point Likert-type responses.

RESULTS

Responses to a repeat survey of healthcare studying in the North West of England in 2015 were strikingly similar overall to those of an original 2011 survey. Although the students were positive overall about their experiences, a number were dissatisfied with some aspects of their experiences - particularly in relation to initial support on campus and whilst studying on placement. Four years on from the original survey, despite a considerable investment in improving students' experiences across the region, there appears to be little change in students' perceptions of their learning experiences CONCLUSION: In the short-term monitoring of student experience needs to be continued; and links to attrition (potential or actual) noted and acted upon. However, given that attrition from these courses has been a long-term problem and the complexity of its resolution a recurrent finding in the literature; new ways of framing and resolving the problem need to be considered.

Managing support for newly qualified practitioners: lessons learnt from one health care region in the UK

AIM

The study mapped the support provided for newly qualified practitioners across Kent, Surrey and Sussex.

BACKGROUND

Newly qualified practitioners require support and guidance to facilitate their transition from student to their new role as qualified practitioner. Professional bodies advocate that programmes be provided but the type and intensity of that support is variable.

METHODS

Telephone interviews were conducted with 24 people delivering support for newly qualified practitioners across professions in 13 different health care trusts. Documents (n = 41) related to support programmes were analysed. Two case study site visits and a knowledge exchange conference of 45 delegates completed the data collection. Data were analysed using the constant comparative method of analysis.

RESULTS

Support for newly qualified practitioners was largely idiosyncratic to profession and Trust. Evidence emerged of a conceptual shift from basic competency acquisition toward a corporate induction programme.

CONCLUSIONS

Interdisciplinary programmes can provide generic transitional support, but the newly qualified practitioners favoured skill acquisition to help them to be effective in their new role. Measuring the impact of newly qualified practitioner support on patient outcome and the practitioner is required.

IMPLICATIONS FOR NURSING MANAGEMENT

A career pathway for those who support newly qualified practitioners and one that includes specific preparation for the role is proposed.

Supporting completion of an online continuing professional development programme for newly qualified practitioners: A qualitative evaluation

BACKGROUND

Development programmes to support newly qualified practitioners gain confidence in their first professional role often show varied levels of engagement, due to competing priorities and demands. In Scotland, the Flying Start NHS® programme uses a structured programme of online and work-based learning with associated mentoring, to support individuals through an often difficult transition to become capable, confident practitioners. Whilst the programme was generally well received, the factors leading to widely varying completion rates between professions and organisations were not well understood.

AIM

The aim of this study was to identify the factors leading to successful completion of Flying Start, a transition programme for newly qualified practitioners.

METHOD

A qualitative approach was adopted to gather data from two groups of participants. Semi-structured telephone interviews were conducted with strategic and management level participants (n=23), from five health boards in Scotland. Semi-structured interviews (n=22) and focus groups (n=11) were conducted with practitioners within 6months either side of completing the programme. The interviews were transcribed and analysed using framework analysis.

RESULTS

Three key themes relating to successful completion emerged from the analysis: Management and Delivery; Content and Material; Participation and Completion. Factors leading to successful completion were identified at programme, organisational and individual levels. These included clear communication and signposting, up-to-date and relevant content, links with continuing professional development frameworks, effective leadership, mentor and peer support, setting clear standards for assessment, and facilitating appropriate IT access.

CONCLUSIONS

A strong strategic commitment to embedding a development programme for newly qualified practitioners can ensure that the necessary support is available to encourage timely completion. The mentor's role - to provide face-to-face support - is identified as a key factor in completion and is achieved through setting attainable targets, monitoring progress, and providing motivation. However organisational structures that facilitate the mentoring relationship are also necessary.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

BACKGROUND

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future.

DISCUSSION

This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered.

SUMMARY

A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost-effectiveness evaluation involving all key stakeholders.

Undergraduate student nurses' perceptions of two practice learning models: a focus group study

BACKGROUND

Phase 1 of this study examined student, mentor and clinical manager's perceptions of a 'Hub and Spoke' practice learning model in year 1 of an undergraduate nursing programme. Findings from Phase 1 suggested that the model had significant educational merit in orientating students to clinical learning and emphasising the primacy of the mentor relationship in developing and supporting students. Following the students through year 2 of their programme, wherein they experienced a 'rotational' practice learning model, which provided an opportunity to explore student perceptions of both models.

AIMS

To explore undergraduate nurses' perceptions of two experienced practice learning models: hub and spoke model, and the classical rotational model. In a previous study the hub and spoke model appeared to develop 1st year students' sense of belongingness, continuity and quality of practice learning, there for it was important to understand what students reported about these issues when recounting their 2nd year experience in the clinical setting that was organised according to a classical rotational model.

DESIGN

Qualitative approach utilising focus groups.

PARTICIPANTS

10 under-graduate student nurses at the end of 2nd year.

METHODS

Focus group interviews.

RESULTS

Students responded in ways that indicate they believed the experiences of year 1 had raised their faith in their ability to cope with the practice learning and educational demands of nursing. They saw themselves as being better prepared for year 2 as a result of their exposure to hubs and spokes. The study has identified traits of resilience, continued belongingness and self-confidence in orientation to learning in clinical practice in hub and spoke experienced students.

CONCLUSIONS

The student nurses found the hub and spoke model valid in 1st year, whilst stating that for 2nd year the rotational model can be valid. This supports earlier findings that student nurses require a structured and supportive 1st year learning environment to enable development of resilience for subsequent years.

A preceptorship programme for newly qualified nurses: a study of preceptees' perceptions

AIM

This paper presents the evaluation of a preceptorship programme for newly-qualified nurses (NQNs) to determine preceptee engagement with the preceptorship programme, and the impact, value and sustainability of the programme from the preceptees' perspectives.

BACKGROUND

The literature suggests that NQNs find the transition from student to qualified nurse to be stressful and that preceptorship can reduce this stress and promote adaptation to the new role.

SETTING

This study took place in one NHS Healthcare Trust in South West London, UK.

PARTICIPANTS

Ninety NQNs were invited to participate in the study and the response rate was 48.9% (n=44). The study took place in 2011.

METHODS

Evaluative research design was used incorporating a fourfold evaluation framework of preceptee engagement, impact, value and sustainability (Ooms et al., 2011). This was a mixed methods study. Qualitative and quantitative data were collected through questionnaires, reflective journals and through personal audio recordings made by the preceptees. Quantitative data were analysed through descriptive statistics and t-tests, and Cronbach's alpha coefficient was used to assess reliability of impact and value scales. In addition analysis of open-ended questions and qualitative data was undertaken using the Framework Method of analysis.

FINDINGS

Findings show that preceptee engagement in the programme was high and preceptorship was highly valued by the majority of preceptees (85%). Preceptors played a positive role in terms of alleviating stress. Preceptorship impacted positively on preceptees in terms of development of communication skills and clinical skills, and role, personal and professional development. In addition, preceptees felt that the programme was of value despite acknowledging difficulties in making time to meet with preceptors. Preceptees also indicated that they would wish to be preceptors in the future and that they would recommend preceptorship to all nurses who are either newly qualified or new in role. Preceptees judged the preceptorship programme positively for engagement, impact, value and sustainability.

CONCLUSION

The study is unique when mapped against other research studies as it explores a breadth of evaluative issues not found in other preceptorship studies, e.g. engagement, impact, value and sustainability of preceptorship. The study adds insights about sustainability of preceptorship programmes and expectations of competence of NQNs that do not appear in previous literature about preceptorship.