Professional socialization: The key to survival as a newly qualified nurse

New Graduate Nurses' Competencies, Organizational Socialization, and Turnover Intention

OBJECTIVE

This study aimed to identify core competencies in new-graduate nurses (NGNs) by determining which competencies affected their organizational socialization (OS) and turnover intention (TI) in their 1st year of employment.

BACKGROUND

NGNs face stressful transitions with expanded nursing responsibilities that motivate them to leave their jobs. Therefore, NGN turnover in the 1st year of practice is higher than the overall nurse turnover rate. Previous research suggested that NGNs' competency levels affect their OS and TI. However, little research has been done to determine which competencies affect these variables.

METHODS

Multiple linear regression analysis was performed on cross-sectional survey data to determine the effects of NGN work competencies on OS and TI.

RESULTS

Health promotion, supervision, interpersonal communication, and direct care competencies significantly predicted NGNs' OS, and computer technology competency significantly predicted NGNs' TI.

CONCLUSIONS

NGNs should be given early opportunities for expanded hands-on clinical experiences along with clear awareness of the organization's goals and values. Moreover, they should be offered roles that take advantage of their computer technology skills and that challenge them to contribute to their organization and nursing care in new ways.

Students' experience of the challenges of using assertive communication

Assertive communication is a skill that many nurses, particularly nursing students, find challenging. This article describes the findings of phenomenological study that set out to explore third-year student nurses' experiences of using assertive communication in the clinical setting. A narrative enquiry approach reviewed six reflective written accounts of their experiences. In addition, seven students took part in an in-depth semi-structured group discussion of their clinical experiences. Data were analysed using a hybrid interpretive phenomenological analysis and discourse analysis framework. Three key themes emerged: a sense of responsibility/duty and a sense of failure when this is not upheld, the importance of mentors in promoting self-confidence and self-esteem, and a sense of belonging on placement. The students responded well to positive role models and were able to identify negative role models. Accurate, constructive feedback and support was important to help students reflect appropriately.

Prioritizing the Interview in Selecting Resident Applicants: Behavioral Interviews to Determine Goodness of Fit

From our initial screening of applications, we assess that the 10% to 15% of applicants whom we will interview are all academically qualified to complete our residency training program. This initial screening to select applicants to interview includes a personality assessment provided by the personal statement, Dean's letter, and letters of recommendation that, taken together, begin our evaluation of the applicant's cultural fit for our program. While the numerical scoring ranks applicants preinterview, the final ranking into best fit categories is determined solely on the interview day at a consensus conference by faculty and residents. We analyzed data of 819 applicants from 2005 to 2017. Most candidates were US medical graduates (62.5%) with 23.7% international medical graduates, 11.7% Doctors of Osteopathic Medicine (DO), and 2.1% Caribbean medical graduates. Given that personality assessment began with application review, there was excellent correlation between the preinterview composite score and the final categorical ranking in all 4 categories. For most comparisons, higher scores and categorical rankings were associated with applicants subsequently working in academia versus private practice. We found no problem in using our 3-step process employing virtual interviews during the COVID pandemic.

Newly graduated nurses' socialisation resulting in limiting inquiry and one-sided use of knowledge sources-An ethnographic study

AIM

To explore how the socialisation into the clinical setting and interaction between newly graduated nurses and experienced nurses influences the new graduates' use of knowledge sources.

BACKGROUND

Newly graduated nurses' use of knowledge sources in decision-making has been subject to an increased interest in relation to evidence-based practice. Despite interventions to strengthen nurses' competencies required for making reflective clinical decisions within an evidence-based practice, studies highlight that new graduates only draw on knowledge from research, patients and other components within evidence-based practice to a limited extent. Research exploring new graduates' use of knowledge sources calls attention to the experienced nurses' decisive role as a valued knowledge source. The new graduates' process of socialisation and their interaction with the experienced nurse raises further questions.

METHODS

Ethnography using participant-observation and individual semi-structured interviews of nine newly graduated nurses from a University Hospital in Denmark. Data were collected in 2014. The study adheres to COREQ.

RESULTS

Two main structures were found: "Striving for acknowledgment" and "Unintentionally suppressed inquiry."

CONCLUSIONS

New graduates are socialised into limiting their inquiry on clinical practice and unintentionally being restricted to using the experienced nurse as predominant knowledge source. Depending on how the experienced nurse responds to the role as predominant knowledge source, they could either limit or nurture the new graduates' inquiry into practice and thus the variety of knowledge sources used in clinical decision-making. Limited inquiry into the complexity of nursing practice indirectly excludes the use of a variety of knowledge sources, which are fundamental to an evidence-based practice.

RELEVANCE

If clinical practice wishes to benefit from the newly graduated nurses' inquiring approach and skills within evidence-based practice, clinical practice will have to greet the nurses with a supportive culture where questioning practice is seen as a strength rather than a sign of insecurity and incompetence.

Modelling nurses' use of local anaesthesia for intravenous cannulation and arterial blood gas sampling: A cross-sectional study

Background

Needle insertions are painful, yet they are frequently performed for adults and children without using local anaesthetic (LA) to minimise pain and anxiety.

Objectives

A hypothetical model was formulated to explore the factors related to Saudi nurses' self-reported readiness to use LA prior to undertaking parenteral procedures in their workplaces.

Design

This was an exploratory, cross-sectional study.

Methods

Four hundred seventy-five nurses were recruited from one hospital in Saudi Arabia. We considered eighteen latent variables related to nurses' attitudes and ability to pursue six roles associated with LA before needle procedures. A model was created to identify the staff attitudes and self-efficacy pathways influencing readiness to use LA.

Results

The nurses' readiness to use LA before needle procedures was directly predicted by organisational factors (e.g., hospital policy, doctors' orders), procedural time constraints, underestimation of needle pain, patient characteristics and medical conditions, nurses' knowledge and skills related to LA, and parenteral procedure practices.

Conclusions

Nurses' readiness to use LA was influenced by their beliefs about certain aspects of their practice and the nature of patients' presenting problems.

Impact statement

Identifying factors that affect LA use helps us understand this issue and may assist policymakers in developing nursing practice.

Relationship between educational stress and psychological resilience in nursing students

Aim: The aim of this study was to determine the relationship between educational stress and psychological resilience in nursing students. Method: The descriptive and analytical design of the study consists of 602 students in the nursing department of the Faculty of Health Sciences of Ordu and Tokat Gaziosmanpasa University. Data were collected using Personal Information Form, Nursing Education Stress Scale (NESS), and Resilience Scale for Adults (RSA). Data, frequency distribution, descriptive statistics (mean, standard deviation) Mann Whitney U test, Kruskal Wallis test, and Spearman correlation test were used. Findings: The mean age of the students was 20.37±2.10, 73.8% of them were women, the mean NESS score was 66.76±16.56, and the mean RSA score was 99.99±5.19. There was a high positive correlation between NESS total, academic and application sub-dimensions, RSA structural style and future perception, NESS total and academic sub-dimension was negatively correlated with social resources and NESS academic and family cohesion. Conclusions: Acording to results,  nursing students experience moderate academic and practice stress. Among the factors that affect students' psychological well-being, there is a positive relationship between personal strength and future goals, quests and adaptation to future, and stress (in practice area). In addition, it can be said that the psychological resilience of the students is moderate when the scores of the students are evaluated. ​Extended English summary is in the end of Full Text PDF (TURKISH) file.   Özet Amaç: Bu çalışmanın amacı, hemşirelik öğrencilerinin eğitim stresi ile psikolojik dayanıklılıkları arasındaki ilişkiyi ve etkileyen faktörleri belirlemektir. Metod: Tanımlayıcı ve analitik tipte planlanan araştırmaya, Ordu ve Tokat Gaziosmanpaşa Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik Bölümünde öğrenim gören 602 öğrenci dahil edilmiştir. Veriler, Kişisel Bilgi Formu, Hemşirelik Eğitimi Stres Ölçeği (HESÖ) ve Yetişkinler için Psikolojik Dayanıklılık Ölçeği (YPDÖ) kullanılarak toplandı. Verilerin analizinde, frekans dağılımı ve tanımlayıcı istatistikler (ortalama, standart sapma), Mann Whitney U, Kruskal Wallis ve Spearman korelasyon testi kullanıldı. Bulgular: Öğrencilerin yaş ortalaması 20.37±2.10, %73.8’i kadın, HESÖ puan ortalaması 66,76±16,56, YPDÖ puan ortalaması ise 99,99±5,19’dur. HESÖ toplam, akademik ve uygulama alt boyutları ile YPDÖ yapısal stil ve gelecek algısı arasında yüksek derecede pozitif yönde, HESÖ toplam ve akademik alt boyutu ile sosyal kaynaklar arasında ve HESÖ akademik ile aile uyumu arasında negatif yönde ilişki olduğu saptandı. Sonuç: Hemşirelik öğrencileri orta düzeyde akademik ve uygulama alanlarında stres deneyimlemektedir. Öğrencilerin psikolojik iyi oluşlarını etkileyen faktörlerden kişisel özellikler ve geleceğe yönelik yeni amaç, arayışlar ve geleceğe uyumları ile stres (uygulama alanında) arasında pozitif ilişki bulunmaktadır.  Ayrıca, öğrencilerin YPDÖ puanlarına bakıldığında, psikolojik dayanıklılıklarının orta derece olduğu söylenebilir.

Why Health Care Professionals Belong to an Intensive Care Virtual Community: Qualitative Study

Background

Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow.

Objective

This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community.

Methods

A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years—between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained.

Results

There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: “Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge.” The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date.

Conclusions

This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

Challenges and facilitators of professional socialization: A systematic review

AIMS

This current study aimed to present a review of the challenges and facilitators of professional socialization among undergraduate nursing students.

DESIGN

Systematic review.

METHODS

A literature search was conducted in Embase, Google Scholar, PubMed and Scopus in April and May 2018 for studies published in the English language. Four thousand three hundred fifty-two articles were retrieved. We conducted further screening for full-text articles after discarding duplicates and irrelevant studies. Finally, eight studies were included. The Joanna Briggs appraisal tools were used to appraise and evaluate study quality. The PRISMA guidelines were followed and a narrative synthesis used for data analysis.

RESULTS

Challenges and facilitators of professional socialization were identified and categorized into two major themes. Under each theme, results were grouped into three sub-themes: professional, personal and educational challenges/facilitators.

New graduate registered nurses' exposure to negative workplace behaviour in the acute care setting: An integrative review

BACKGROUND

Negative workplace behaviour among nurses is a globally recognised problem and new graduate nurses are at high risk for exposure. Negative behaviour has detrimental effects on new graduate nurses, the nursing profession and patients.

OBJECTIVES

To synthesise evidence on negative workplace behaviour experienced by new graduate nurses in acute care setting and discuss implications for the nursing profession.

DESIGN

An integrative review guided by Whittemore and Knafl's (2005) framework.

DATA SOURCES AND REVIEW METHODS

A search of evidence-based research from five electronic databases (CINAHL, MEDLINE, ProQuest, JBI and Scopus) was conducted for the period of 2007-2017. Eligible articles were critically appraised using the Mixed Methods Appraisal Tool.

RESULTS

Eight qualitative and eight quantitative studies were identified and reviewed. There was a variety of terms and definitions used to describe the disrespectful, unprofessional and uncivil targeted behaviour towards new graduate nurses. The incidence of negative workplace behaviour varied from 0.3% as a daily occurrence to 57.1% experiencing sporadic exposure. The precipitating factors included the new graduates' perceived lack of capability, magnifying power and hierarchy, leadership style and influence of management. The negative behaviour was identified as either a personal or professional attack, which left new graduates feeling emotional distress, anxiety or depression, which in turn impacted upon job satisfaction, cynicism, burnout, and intention to leave. The lack of a definitional consensus and the range of negative workplace behaviour make identification, seeking assistance and intervention difficult. Specific or ongoing organisational support to address negative behaviours towards new gradute nurses was not identified. Instead, the way they used to deal with these behaviours were personal.

CONCLUSION

Negative workplace behaviour towards new graduate nurses continues to be an international problem. Available studies are descriptive and exploratory in nature and there have been few effective strategies implemented in acute care setting to address towards new graduate nurses. Multi-level organisational interventions are warranted to influence the 'civility norms' of the nursing profession. With a new understanding of the theoretical underpinnings of negative workplace behaviours towards new graduate nurses and the identification of limited intervention studies being undertaken, the nursing profession is provided with new directions in their future endeavours.

Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach

BACKGROUND

Nurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters.

OBJECTIVES

This study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care.

DESIGN

This study used an exploratory design, employing a qualitative approach.

DATA SOURCES

14 in depth interviews with Dutch bachelor novice nurses with 0-5 years of practical experience took place.

REVIEW METHODS

Thematic analysis and inductive coding was used.

RESULTS

Four themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described.

CONCLUSION

Compassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.

Professional Socialization of Iranian BSN Students: A Grounded Theory Study

Introduction: Professional socialization is a critical aspect of nursing students’ development, which begins with entry into the nursing program and continues when their professional practice begins. The aim of this study was to explore the socialization of Iranian BSN students in the nursing profession.

Methods: An exploratory qualitative approach utilizing Straussian version of the grounded theory (1998) method was used. Individual in-depth semi-structured interviews were undertaken with 14 participants chosen from two large nursing schools in an urban area through purposive and theoretical sampling. The data were analyzed, using the constant comparative method.

Results: Five main categories and eleven subcategories emerged and integrated around one core category. Professional metamorphosis as the core variable was a complex and interrelated process (consisting of three stages: dependence, disintegration, and integration) with dynamic, ongoing, and personal features influenced by professional and extra-professional context. The students assumed a passive role in the initial of their studies. However, during the last year of the educational program, they gradually involved actively in dealing with own personal and professional issues.

Conclusion: This study introduced "professional metamorphosis of BSN students" as a substantive grounded theory in the socio-cultural context of the health care system in Iran. During this process, students move from outsider personal position to insider professional position. The nurse educators and administrators may develop effective educational interventions to promote professional socialization of students with an understanding of the promoting and driving forces influencing socialization.

Nursing students' socialisation into practical skills

Socialisation is a significant factor that shapes nursing students' learning in clinical settings. Little is known about the ways in which students learn practical skills during their clinical practice and how they are socialised into these skills. This knowledge is important for creating an optimal environment for ensuring a high standard of care and patient safety. This study aims to address this knowledge gap. An ethnographic approach was used. Data were collected by participant observations during nursing students' clinical practice in an emergency department at a university hospital in Sweden, and during informal conversations with students and their preceptors. In the analysis, four themes emerged: A reflective approach based on a theoretical framing; Multitasking situations; Shifts in an active role as a nursing student; and Styles of supervision. Students' socialisation into practical skills was shaped by several factors where preceptors played a key role. Teaching and learning styles and interactions between the preceptor and the student shaped the learning situations. A dominant discrepancy regarding whether and how reflections took place between preceptors and students was identified. This highlights the need for creating continuity between the ways that experiences are organised across the settings of learning (university-based and clinically based learning) to enhance nursing students' learning and socialisation into practical skills.

Exploration of difficult conversations among Australian paramedics

Previous studies indicate that healthcare professionals find it challenging to engage in difficult conversations regarding concerning behavior of colleagues. As a result, these conversations are often avoided. The inability to have these difficult conversations is associated with poorer patient outcomes, staff commitment, discretionary effort, and employee satisfaction. This descriptive study used an online questionnaire to examine responses of paramedics employed by Ambulance Victoria (Australia) regarding difficult conversations between colleagues about concerning behavior of co-workers. The results suggest that, like other healthcare professions, many paramedics find it challenging to raise these concerns. To the best knowledge of the authors, this is the first study of its type to be undertaken within the paramedic profession and provides a platform for further research within this and other health professions.

Blurring the boundaries: using institutional ethnography to inquire into health professions education and practice

CONTEXT

Qualitative, social science approaches to research have surged in popularity within health professions education (HPE) over the past decade. Institutional ethnography (IE) offers the field another sociological approach to inquiry. Although widely used in nursing and health care research, IE remains relatively uncommon in the HPE research community. This article provides a brief introduction to IE and suggests why HPE researchers may wish to consider it for future studies.

METHODS

Part 1 of this paper presents IE's conceptual grounding in: (i) the entry point to inquiry ('materiality'), (ii) a generous definition of 'work' and (iii) a focus on how 'texts' such as policies, forms and written protocols influence activity. Part 2 of this paper outlines the method's key features through exemplars from our own research. Part 3 discusses the ways in which research that blurs the lines between educational and clinical practice can be both generative for HPE and accomplished using IE.

RESULTS

The authors demonstrate the usefulness of IE for studying complex social issues in HPE. It is posited that a key added value of IE is that it goes beyond individual-level explanations of problems and phenomena, yet also closely studies individuals' activities, rather than remaining at an abstract or distant level of analysis. Thereby, IE can result in feasible and meaningful social change at the nexus of health professions education and other social systems such as clinical practice.

CONCLUSIONS

IE adds to the growing qualitative research toolkit for HPE researchers. It is worth considering because it may enable change through the study of HPE in relation to other social processes, structures and systems, including the clinical practice world. A particular benefit may be found in blending HPE research with research on clinical practice, toward changing practice and policy through IE, given the interrelated nature of these fields.

Can Social Cognitive Theories Help Us Understand Nurses' Use of Electronic Health Records?

Electronic health record implementations have accelerated in clinical settings around the world in an effort to improve patient safety and enhance efficiencies related to care delivery. As the largest group of healthcare professionals globally, nurses play an important role in the use of these records and ensuring their benefits are realized. Social cognitive theories such as the Theory of Reasoned Action, Theory of Planned Behaviour, and the Technology Acceptance Model have been developed to explain behavior. Given that variation in nurses' electronic health record utilization may influence the degree to which benefits are realized, the aim of this article is to explore how the use of these social cognitive theories may assist organizations implementing electronic health records to facilitate deeper-level adoption of this type of clinical technology.

Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory

BACKGROUND

Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems.

OBJECTIVES

To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom.

DESIGN

Data of a longitudinal qualitative nature were collected and analysed using grounded theory.

SETTINGS

First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks.

PARTICIPANTS

A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement.

METHODS

Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained.

RESULTS

The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status.

CONCLUSIONS

Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

Views of pharmacy graduates and pharmacist tutors on evidence-based practice in relation to over-the-counter consultations: a qualitative study

RATIONALE, AIMS AND OBJECTIVES

Health care services offered to the public should be based on the best available evidence. We aimed to explore pharmacy tutors' and trainees' views on the importance of evidence when making decisions about over-the-counter (OTC) medicines and also to investigate whether the tutor influenced the trainee in practice.

METHODS

Following ethical approval and piloting, semi-structured interviews were conducted with pharmacy graduates (trainees) and pharmacist tutors. Transcribed interview data were entered into the NVivo software package (version 10), coded and analysed via thematic analysis.

RESULTS

Twelve trainees (five males, seven females) and 11 tutors (five males, six females) participated. Main themes that emerged were (in)consistency and contradiction, confidence, acculturation, and continuation and perpetuation. Despite having an awareness of the importance and potential benefits, an evidence-based approach did not seem to be routinely or consistently implemented in practice. Confidence in products was largely derived from personal use and patient feedback. A lack of discussion about evidence was justified on the basis of not wanting to lessen patient confidence in requested product(s) or possibly negating the placebo effect. Trainees became acculturated to 'real-life' practice; university teaching and evidence was deemed less relevant than meeting customer expectations. The tutor's actions were mirrored by their trainee resulting in continuation and perpetuation of the same professional attitudes and behaviours.

CONCLUSIONS

Evidence appeared to have limited influence on OTC decision making. The tutor played a key role in the trainee's professional development. More work could be performed to investigate how evidence can be regarded as relevant and something that is consistently implemented in practice.

New nurse transition: success through aligning multiple identities

Purpose

– The purpose of this paper is to explore the perceptions of new nurses in Singapore of their experiences of role transition and to examine the implications for managers in terms of employee training, development and retention.

Design/methodology/approach

– This qualitative study was conducted using a constructivist grounded theory approach. In total 26 novice nurses and five preceptors (n=31) from five different hospitals participated in the study. Data were collected from semi-structured interviews and reflective journal entries and analysed using the constant comparative method.

Findings

– The findings revealed that novice nurses remained emotionally and physically challenged when experiencing role transition. Two major constructs appear to play an important part in the transition process; learning how to Fit in and aligning personal with professional and organisational identities. The findings highlight factors that facilitate or impede Fitting in and aligning these identities.

Originality/value

– Although the concept of Fitting in and its relation to the attrition of novice nurses has been explored in global studies, that relationship has not yet been theorised as the dynamic alignment of multiple identities. Also, whilst most research around Fitting in, identity and retention has been conducted in western countries, little is known about these issues and their interrelationship in the context of Singapore. The study should inform decision making by healthcare organisations, nurse managers and nursing training institutions with respect to improving the transition experience of novice nurses.

Student paramedic experience of transition into the workforce: A scoping review

OBJECTIVES

In this article we present the findings from a scoping review that sought to identify what is known about the experiences of paramedic students transitioning into the workforce.

BACKGROUND

Within the emergency healthcare sector, paramedics are primarily tasked with the assessment, treatment and safe transport of patients to hospital. New paramedics entering the workforce are exposed to the full extent of human emotion, injury and suffering as part of their everyday work. There is evidence from other healthcare disciplines that the transition to practice period can be difficult for new graduates.

METHODS

We utilised Arksey and O'Malley's five-stage scoping review framework to identify what is known about the transition of paramedicine graduates to the workplace. The framework involves identifying relevant studies; study selection; charting the data; and collating, summarizing and reporting results.

RESULTS

We identified eleven articles that explored transition of newly qualified paramedics. Thematic content was identified and discussed into four separate categories. Each theme revealing the emotional, physical and social impacts new paramedics face as they strive to find acceptance in a new workplace and culture.

CONCLUSION

Given the significant role that paramedics have in modern healthcare, the transition from student to practitioner is a period of significant stress to the new paramedic. Limited research in this field though inhibits a thorough understanding of these issues.

Respect in final-year student nurse-patient encounters - an interpretative phenomenological analysis

Very little is known regarding health-care professionals' understanding and experiences of respect towards patients. The study aimed to explore student nurses' understanding and experiences of respect in their encounters with patients. Semi-structured interviews were conducted with eight final-year student nurses with practice placements across different health-care trusts in the UK. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three super-ordinate themes were identified: understanding of what it means to show respect, negotiating role expectations and personal attitudes in practice, and barriers related to the performance of the nursing role. The factors identified should be investigated further and addressed as they are likely to influence patients' experiences of feeling respected in nurse–patient interactions and subsequently their well-being and health-related behaviours.

Comparative study of an externship program versus a corporate-academic cooperation program for enhancing nursing competence of graduating students

BACKGROUND

New graduates report intense stress during the transition from school to their first work settings. Managing this transition is important to reduce turnover rates. This study compared the effects of an externship program and a corporate-academic cooperation program on enhancing junior college students' nursing competence and retention rates in the first 3 months and 1 year of initial employment.

METHODS

This two-phase study adopted a pretest and posttest quasi-experimental design. All participants were graduating students drawn from a 5-year junior nursing college in Taiwan. There were 19 and 24 students who participated in the phase I externship program and phase II corporate-academic cooperation program, respectively. The nursing competence of the students had to be evaluated by mentors within 48 hours of practicum training and after practicum training. The retention rate was also surveyed at 3 months and 1 year after beginning employment.

RESULTS

Students who participated in the corporate-academic cooperation program achieved a statistically significant improvement in nursing competence and retention rates relative to those who participated in the externship program (p < 0.01 and p < 0.05, respectively).

CONCLUSIONS

The corporate-academic cooperation program facilitates the transition of junior college nursing students into independent staff nurses, enhances their nursing competence, and boosts retention rates.

Concept analysis of professional socialization in nursing

PURPOSE

The aim of this study is to clarify the process of professional socialization, and to identify its attributes, antecedents, and consequences in nursing. Rodgers' evolutionary method of concept analysis was used to clarify the concept of professional socialization in the field of nursing.

SOURCE

A literature review was conducted by performing a search on scientific databases using the key terms "socialization," "professional socialization," and "nursing." Four hundred forty-six papers for the period 1995-2009 were found, out of which 47 articles and 4 books were selected for the analysis. The process was audited by two independent experts in order to ensure neutrality and credibility.

CONCLUSION

Professional socialization is a complex process with four critical attributes: learning, interaction, development, and adaptation. Comprehensive educational programs, competent role models, and the provision of adequate field experiences were found to be the antecedents of these attributes. They have either positive or negative consequences for the professional development of nurses. These findings not only add to the body of knowledge, but also serve as an important impetus for further theory development and research in nursing.

Student nurse socialisation in compassionate practice: a Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

The relationship between continuing professional education and horizontal violence in perioperative practice

Continuing professional development must be undertaken by all registered perioperative practitioners. However, interviews with 23 perioperative nurses employed by one NHS trust suggested a link between workplace culture and intra-professional conflict which was associated with horizontal violence and perceived as a direct consequence of formal study. Such experiences appeared to affect participants' study and their psychological wellbeing. Further work is required to explore this concept.

Clinical research ethics in Irish healthcare: diversity, dynamism and medicalization

Gaining ethical clearance to conduct a study is an important aspect of all research involving humans but can be time-consuming and daunting for novice researchers. This article stems from a larger ethnographic study that examined research capacity building in Irish nursing and midwifery. Data were collected over a 28-month time frame from a purposive sample of 16 nurse or midwife research fellows who were funded to undertake full-time PhDs. Gaining ethical clearance for their studies was reported as an early 'rite of passage' in the category of 'labouring the doctorate'. This article penetrates the complexities in Irish clinical research ethics by describing the practices these nurse and midwife researchers encountered and the experiences they had. The key issue of representation that occurred in the context of 'medicalized' research ethics is further explored including its meaning for nursing or midwifery research.

Nurses' research utilization two years after graduation--a national survey of associated individual, organizational, and educational factors

Background

Nurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses’ RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses’ RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.

Methods

Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses’ instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.

Results

Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.

Conclusions

A number of factors associated with nurses’ low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses’, specifically newly graduated nurses’, RU.

Newly Licensed RNs Describe What They Like Best about Being a Nurse

About 25% of newly licensed registered nurses (NLRNs) leave their first job within two years, but only 2% leave the nursing profession in this same timeframe. Therefore, the researchers sought to discover what new nurses like best about being a nurse, in hopes of gaining information that might help facilities to reduce turnover rates. Data were collected between January and March 2009 from 1,152 NLRNs licensed in 15 US states. Krippendorff's method was used to analyze survey responses. Five themes emerged: “providing holistic patient care,” “having an autonomous and collaborative practice,” “using diverse knowledge and skills to impact patient outcomes,” “receiving recognition,” and “having a job that is secure and stimulating.” Strategies are discussed that organizations might employ in helping NLRNs to realize what they best like about their work, which might lead to improved retention rates.

Professional socialization in dietetics: a review of the literature

The process of professionalization has been widely studied in nursing, but little is known about it in dietetics. We explored the process of professionalization using an integrative review of nursing literature. Three research questions were addressed: 1. What are the stages of professional socialization? 2. Who are the participants in the socialization process? 3. What challenges are associated with the socialization process? From an initial list of 322 articles compiled from a search of relevant databases, 49 English-language primary research papers were selected for review. A form of constant comparative analysis was conducted to extract relevant data into categories based on the research questions. Findings suggest that the process of professional socialization is a complex and stressful process, which occurs in three phases and begins before entry into the formal education system. Within the formal education system, faculty and preceptors can have a positive or negative impact on an individual's professional growth and development. Much work is needed to develop an understanding of this process in dietetics, but the findings will have immediate relevance to dietitians' educational and practice contexts.

Empowerment and enterprise: the political economy of nursing

Throughout the past decades, Australian nursing has made significant advances in the clinical, research, and political arenas. Capitalising on these advances is a critical step in empowering the professions and a sound investment in the health of the nation. There remains a need to energise and empower the professions, to see our work as an enterprise that has value and a sense of worth because of our professional activities as well as for the political and economic contributions we make to health and wellbeing, quality of life and social justice. The contributions made by nurses and midwives need to be articulated in the policy arena, focused in professional decision-making and elaborated in our research agendas. Our professional organisations provide opportunities for solidarity, and the leverage we need to effect change at the bedside, the community and the whole of society. Renewed commitment to primary health care at the global, national and community level provides a timely rallying call to the professions to refine the way we articulate our position in health care, re-commit to culturally appropriate, socially just actions and embolden our professional goals to inspire the next generations of nurses for a more equitable future.

"This is nursing": nursing roles as mediated by precepting nurses during clinical practice

In nursing education, it has been argued that professional socialization is facilitated by clinical experiences where students work together with precepting nurses. However, few studies found have focused on how nurses think and act as preceptors, hence providing a base for professional socialization to occur. Therefore; this study aimed to describe how preceptors mediated nursing as a profession to undergraduate nursing students during clinical practice. This was an ethnographic study guided by symbolic interactionism. A purposeful sampling of 13 precepting nurses was observed during the field work period. In addition, 16 staff nurses, purposively selected, and experienced in precepting, participated in focus group interviews. All text from field notes and interviews were read as a whole and analyzed following the ethnographic approach. Findings illustrated how nursing was mediated as the medical-technical, the administrative, and the caring role. Preceptors aimed for professionalism in their students by teaching the students to reflect on what they can do independently as nurses. Preceptors strived to verbalise their practical knowledge to make theory explicit and contextualize to student nurses. This knowledge can guide implementation of preceptor programmes focusing on the meaning and implications of professionalism.