The prevailing winds of oppression: understanding the new graduate experience in acute care

Echoes of silence

Communication is an integral part of nursing practice-with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the 'other', language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing silence to speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly.

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.

Transition Into Practice: Outcomes of a Nurse Residency Program

Background Nurse residency programs (NRPs) have been proposed to meet the educational needs of new graduate nurses and facilitate the transition into practice. Although most studies indicate the benefits of NRPs to assist nurses during transition into practice, only one study compared an NRP with a control group. This study examined whether nurses in an NRP transitioned into practice more successfully than nurses in a traditional orientation program. Method This study enrolled 106 newly employed graduate nurses into study arms by unit: a nurse residency intervention group or a control group of standard nursing orientation. Casey-Fink Readiness for Practice, Nurse Retention, and Nurse Job Satisfaction surveys measured group outcomes. Results Readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed marked improvement. Conclusion The NRP resulted in improved readiness for practice, improved nurse retention, and higher job satisfaction compared with standard orientation. [J Contin Educ Nurs. 2023;54(1):32-39.].

Paolo Freire’s Pedagogy of the Oppressed

Several factors predispose nursing to being regarded as an oppressed profession. A majority of nurses are female; the role of the nurse is often seen as being under the direction of physician’s orders; and the nature of nurses’ clinical practice is seen as task driven. We propose that nursing can be liberated from this image of oppression by transforming nursing education to empower nurses to embrace the fullness of their practice of caring: Providing all human beings with dignity and valuing the care they provide as equally vital to the human condition as the focus on curing is to their physician counterparts. Paolo Freire’s Pedagogy of the Oppressed proposes an educational model in which the teacher embraces the authentic thinking required of students in order to fully grasp their role, respecting what each student brings with them and recognizing the value of that knowledge. Trust must be built at every level of health care, beginning with nurses and their educators engaging in relationships rooted in communication, connection, and the ability to engage in productive dialogue. Should students and educators in nursing programs embrace the words of Freire, a transformation can take place in the health-care system. Nurses and nursing students will no longer carry the weight of oppression with them into the workforce.

Exploring the use of simulation to develop leadership skills in undergraduate nursing students: a scoping review protocol

OBJECTIVE

This review will explore the use of simulation to develop leadership skills in nursing students in undergraduate nursing education programs.

INTRODUCTION

Leadership skills are traditionally incorporated into nursing curriculum as a stand-alone course. A demonstrated need for leadership skills in nursing graduates and recent evidence on the effectiveness of simulation in nursing education programs has led to increased use of simulation to develop leadership skills in undergraduate nursing students. Identification, explication, and mapping of the various strategies are required to help advance the use of simulation to develop leadership skills in nursing education.

INCLUSION CRITERIA

Papers that focus on the use of simulation strategies specifically related to the development of nursing leadership skills in undergraduate nursing students will be included. Papers focused on post-registration/licensure nurses, graduate nurses, nurse practitioners, midwives, allied health care professionals, or psychomotor nursing skills will be excluded.

METHODS

This review will be conducted in accordance with JBI methodology for scoping reviews and will consider English-language literature from 2000 to the present. Data will be extracted from the following databases: CINAHL Plus with Full Text (EBSCO); MEDLINE (R) and Epub Ahead of Print (Ovid), In-Process, In-Data-Review and Other Non-Indexed Citations, and Daily and Versions (R); PsycINFO (Ovid); Embase (Ovid); ERIC (EBSCO); and ProQuest Nursing and Allied Health Source. The search will also include unpublished non-peer-reviewed literature.

Exploring social-based discrimination among nursing home certified nursing assistants

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the phenomenon of social-based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social-based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower-class workers and subsequently improving resident care delivery.

How do new graduated nurses from a competency-based program demonstrate their competencies? A focused ethnography of acute care settings

BACKGROUND

Following major organizations' recommendations, healthcare professionals' education has been reformed in the last decade into competency-based education (CBE) to better prepare them with core competencies. This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how new graduate nurses (NGNs) from these reformed programs use the competencies they have developed.

OBJECTIVE

To describe the competencies of NGNs from a Canadian competency-based baccalaureate program, as perceived by various actors in acute-care settings.

METHODS

A focused ethnography was conducted on three acute-care wards of an academic hospital. Participants (n = 19) from four subgroups (NGNs, preceptors, clinical nurse specialists, and nurse managers) participated in individual semi-structured interviews or focus groups. Data were also collected through observation and fieldnotes; an ethnographic analysis framework was used.

RESULTS

Three themes were identified to describe the deployment of NGNs' competencies: NGNs' appropriation of their new role, fragmentation of practice into tasks, and development of practice; NGNs' collaboration within the interprofessional team, management of the dyad with licensed practical nurses, and ability to integrate patients and families into the team; and NGNs' scientific practice, increased scientific curiosity, and use of credible sources. Analysis of these themes' elements in light of the competency framework of the program showed that NGNs deploy seven of the eight competencies developed during their training.

CONCLUSION

This study's results can be applied by nursing educators and hospital decision makers to ensure NGNs are able to use their competencies and to smoothen the transition period between the academic and clinical settings.

Factors influencing the practice of new graduate nurses: A focused ethnography of acute care settings

AIM

To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency-based undergraduate programme.

BACKGROUND

In the last 15 years, nursing education has shifted to competency-based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment.

DESIGN

A focused ethnography of three acute care units from one academic hospital in Canada.

METHODS

Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and nurse managers (n = 4). Data were collected through individual interviews, focus groups, observation and documentation. Data were analysed according to Roper and Shapira (Ethnography in nursing research. Thousand Oaks, CA: Sage Publications, 2000) ethnographic nursing analysis framework.

RESULTS

Organisational and individual factors were identified as influencing NGNs' competency deployment. Organisational factors are orientation, stability, workload and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognise nursing expertise.

CONCLUSION

One way to smooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies.

RELEVANCE TO CLINICAL PRACTICE

Organisational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies.

Identifying the needs of critical and acute cardiac care nurses within the first two years of practice in Egypt using a nominal group technique

Nursing in Egypt faces many challenges and working conditions in health care settings are generally poor. Little is known about the needs of new nurses transitioning in Egypt. The literature focuses on the first year of practice and only a small body of research has explored the transition needs within acute care speciality settings. This paper reports on the important professional needs of new graduate nurses working in an acute cardiac setting in Egypt during the first two years of practice and differences between their perceived most important needs. The total population participated and two group interviews were conducted (n = 5; n = 6) using the nominal group technique. Needs were identified and prioritised using both rankings and ratings to attain consensus. Content analysis was conducted to produce themes and enable cross-group comparison. Rating scores were standardised for comparison within and between groups. Both groups ranked and rated items as important: 1) education, training and continued professional development; 2) professional standards; 3) supportive clinical practice environment; 4) manageable work patterns, and 5) organisational structure. It is important that health care organisations are responsive to these needs to ensure support strategies reflect the priorities of new nurses transitioning in acute care hospitals within Egypt.

Medical Aesthetics Training: Shifting to Collective Competence

With increased demands for medical aesthetics procedures and the sudden profusion of newly licensed, and unlicensed, providers who are performing these medical aesthetics procedures also comes the responsibility to shift to collective competence. Collective competence refers to what occurs among professionals in action, emphasizing the sharing of experiences, knowledge, and perceptions among those who are providing services to the medical aesthetics client. Registered nurses and medical students are not taught to perform cosmetic procedures in basic nursing or medical programs and thus require a post-entry-level education to validate their competency. The current medical aesthetics apprenticeship training approach of see one, do one, and teach one focuses on teaching technical skills and thus does not sufficiently address the ever-changing health care context and the ambiguity in practitioner role. Recent scholars highlight that when health care failed or an error has been identified, it is rarely adduced to an individual's competence but rather is more likely to be a failure of the collective team. In this article, we are advocating for a change in how medical aesthetics practitioners are trained. In particular, it advocates creating opportunities within the curricula to train practitioners as a collective body, as opposed to providing training that focuses on the individual's competence and technical skills alone.

Equity in nursing care: A grounded theory study

BACKGROUND:

Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health.

OBJECTIVES:

This study was conducted to explain the process of the realization of equity in nursing care.

RESEARCH DESIGN:

This qualitative study uses Glaser's approach to grounded theory.

PARTICIPANTS AND RESEARCH CONTEXT:

Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the "Six C's" coding family of Glaser.

ETHICAL CONSIDERATIONS:

The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects.

FINDINGS:

According to the findings, participants' main concern in providing equitable care is the rationing of nursing care. The identification of participants' main concern led to the emergence of the core category of the study, that is, "nurses' domination." The other categories revolving around the core category were conceptualized according to the six C's coding family: "nurses being dominated," "nurses' ineffective power in the health system," "low attention to equitable care in health system," "lack of clarity in measuring equitable care," "the health structure's inconsistency with equity," and "the inefficiency of the care system."

CONCLUSION:

There is a mutual relationship between providing fair care and nurses' perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.

Light at the end of the tunnel: New graduate nurses' accounts of resilience: A qualitative study using Photovoice

BACKGROUND

Resilience is the ability to overcome any stressful situation. The ability to bounce back is said to enable a person to emerge stronger, perform better, and become more confident and selfefficient. The new graduate nurses' journey is a stressful experience as they become immersed in the day-to-day work pressures.

OBJECTIVE

The study explored the new graduate nurses' accounts of resilience and the facilitating and impeding factors in building their resilience.

METHODS AND PARTICIPANTS

A qualitative study using Photovoice was employed in this study and guided by the theory of Sense of Coherence. Nine new graduate nurses from one university and working for a year in one university-affiliated hospital in Singapore were interviewed and data was subjected to thematic analysis.

FINDINGS

Four themes emerged: (1) resilience is persevering and overcoming obstacles; (2) resilience is accepting one's responsibilities and fulfilling them; (3) resilience is adapting to new situations; and (4) resilience is taking control of own learning. The exhaustive account of their resilience is portrayed as "light at the end of the tunnel".

CONCLUSION

In spite of the stressful working environment and obstacles encountered as new graduate nurses, participants' resilience is built upon the comprehensibility, meaningfulness and management of any situation they face in their personal, spiritual and professional life. Future research is needed to objectively measure their level of Sense of Coherence and association with their level of resilience.

Essential Professional Behaviors of Nursing Students and New Nurses: Hospital Nurse Leader Perspectives Survey

AIM

This two-part study was conducted to determine which professional behaviors hospital nurse leaders believe are essential for nursing students to learn in the classroom.

BACKGROUND

Nursing students need to be educated to lead high-quality care in complex health care environments. Little is known regarding the professional behaviors deemed essential for novice nurses.

METHOD

Hospital leaders were surveyed (n = 221) using the Hospital Nurse Leader Perspectives survey. This survey, developed from interviews, includes 41 items in change, communication, conflict, leadership, and self-awareness.

RESULTS

The highest-ranked category was communication (n = 159, 72 percent), followed by self-awareness (n = 32, 14.4 percent). The highest items in each category were patient communication, prioritization, expect change, learning from failure, and conflict resolution.

CONCLUSION

The results provide practical information to inform curricula and prepare leaders.

Strategies for Successful Perioperative Orientation

The successful orientation of new employees facilitates their transition to the complex and demanding world of perioperative nursing. Whether a nurse is a recent graduate or an experienced nurse who has recently joined the facility or department, a new nurse benefits from a transition period during which new skills, processes, and concepts can be learned. Training should offer new employees the opportunity to develop competency, experience, collegial relationships, clinical judgment, and, overall, specialized knowledge for application in the clinical setting. Concerns surrounding orientation and training include the initial costs for training and the possibility of new employees leaving after the completion of training. The associated costs can be staggering, but adopting perioperative nurse residency programs may be a way to provide quality, high-level training and improve retention rates while minimizing long-term costs.

From Vulnerability to Dignity: The RN Declaration of Self-Esteem

BACKGROUND

Registered nurses (RNs) experience vulnerability from a variety of sources in today's healthcare organizations. While RN vulnerability can be associated with positive outcomes with patients and clients, vulnerability can also be dangerous to RNs as they struggle with outside forces that many feel they have no control over.

AIMS

The study aims to maintain and enhance the dignity of RNs and provide a beacon to RNs who may have become wounded in the healthcare setting and/or their own profession.

SETTING

The study was conducted in a conference entitled "Advancing Nursing Practice Through Change, Innovation and Creativity" held at a midsized university in western Canada.

PARTICIPANTS

The participants were 115 administrators, members of RN regulatory bodies, nursing faculty, nurse educators, and staff nurses.

METHODS

An activity entitled "Wild Thinking" gave participants an opportunity to reflect upon the conference and their personal experiences of change, innovation, and creativity they wished to see within the workplace. All responses were collected at the end of the activity, transcribed verbatim, and analyzed for themes.

RESULTS

Arising from 16 themes, the RN Declaration of Self-Esteem was created.

CONCLUSION

The RN Declaration of Self-Esteem may be helpful in promoting empowerment at the individual RN level as well as in the collective professional level. Janzen Mitchell Renton Currie Nordstrom.

Nurses, the Oppressed Oppressors: A Qualitative Study

Healthcare equity, defined as rightful and fair care provision, is a key objective in all health systems. Nurses commonly experience cases of equity/inequity when caring for patients. The present study was the first to explain nurses' experience of equal care. A qualitative study sought to describe the experiences of 18 clinical nurses and nurse managers who were selected through purposive sampling. The inclusion criteria were the nurses' familiarity with the subject of the study and willingness to participate. The data were collected through in-depth, unstructured, face-to-face interviews. The sampling continued up to data saturation. All the interviews were recorded and then transcribed word by word. The data were analyzed using thematic analysis. The major theme extracted in this study was the equation between submissiveness and oppression in nurses. It had two subthemes, namely the oppressed nurse and the oppressive nurse. The first subtheme comprised three categories including nurses' occupational dissatisfaction, discrimination between nursing personnel, and favoring physicians over nurses. The second subtheme consisted of three categories, namely habit-oriented care provision, inappropriate care delegation, and care rationing while neglecting patient needs. When equal care provision was concerned, the participating nurses fluctuated between states of oppression and submissiveness. Hence, equal conditions for nurses are essential to equal care provision. In fact, fair behavior toward nurses would lead to equity nursing care provision and increase satisfaction with the healthcare system.

No place to turn: nursing students' experiences of moral distress in mental health settings

While researchers have documented the significant issue of moral distress among nurses, few have explored moral distress among mental health nurses. In addition, no research to date has explored nursing students' experiences of moral distress during mental health clinical rotations, despite nursing students typically reporting negative attitudes towards mental health nursing. This manuscript reports on a qualitative study involving seven Canadian baccalaureate nursing students, who reported on their experiences of moral distress during a 13-week clinical rotation on inpatient psychiatric units. Overall, nursing students reported significant moral distress related to the perceived lack of nurses talking meaningfully to patients on the unit, a hierarchical power structure for physicians, a lack of information given to patients about their psychiatric medications, and an inability of their nursing instructors to advocate for ethical change on the units. Several students made a specific connection between their moral distress and not wanting to pursue a career in mental health nursing.

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.

Incivility, retention and new graduate nurses: an integrated review of the literature

AIM

To evaluate the influence of incivility on the new graduate nurse transition experience.

BACKGROUND

Incivility in the work environment is a major source of dissatisfaction and new graduate nurses are especially vulnerable. Incivility contributes to the high levels of turnover associated within the first 2 years of new graduate nurse employment.

EVALUATION

An integrated review of the literature was conducted using MEDLINE-EBSCOhost, PsycInfo and CINAHL databases. Relevant articles were reviewed for appropriateness related to inclusion/exclusion criteria and for quality using established criteria. Sixteen studies were included in the final analysis.

KEY ISSUES

Themes that emerged included workplace incivility, nurse residency programmes, mentoring through preceptors and empowerment/work environment. Findings indicated that incivility in the workplace was a significant predictor of low job satisfaction in new graduate nurses transitioning into practice.

CONCLUSIONS

While graduate nurse transition programmes are associated with improved satisfaction and retention, they appear to address incivility by acculturating new graduate nurses to the experience of incivility. There is little evidence that the culture of incivility has been addressed.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers have the responsibility to be aware of the prevalence of incivility, assess for its occurrence, and implement strategies which eliminate workplace incivility and tolerance for uncivil behaviours.

Nurses' role transition from the clinical ward environment to the critical care environment

AIM

To explore the experiences of nurses moving from the ward environment to the critical care environment.

BACKGROUND

Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment.

METHODOLOGY

A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis.

RESULTS

Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support.

CONCLUSION

The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process.

Preceptors' perceptions of a preceptorship programme for newly qualified nurses

BACKGROUND

A study was undertaken into preceptors' perceptions of a preceptorship programme for newly-qualified nurses. The preceptorship programme is designed to enable newly qualified nurses to make the transition from student to registered nurse. Preceptors undergo a training programme to take on the role of preceptor.

OBJECTIVES

To evaluate the preceptors' perception of the preceptorship programme.

DESIGN

Mixed method evaluative research design was used.

SETTING

This study took place in one National Health Service Healthcare Trust in South West London, UK.

PARTICIPANTS

Ninety preceptors were invited to participate in the study and the response rate was 44.4% (n=40). The study took place in 2011.

METHODS

Qualitative and quantitative data were collected through questionnaires and one-to-one interviews with a convenience sample of preceptors. Quantitative data were analysed using SPSS, version 18; qualitative data were analysed using the Framework Method.

FINDINGS

From the quantitative data seven themes emerged. These were preceptors' perceptions of: the personal development of preceptees; the role development of preceptees; the communication skills development of preceptees; the clinical development of preceptees; the development of professional relationships by preceptees; value of the preceptorship programme to the organisation and value of being a preceptor in terms of their own professional development. Qualitative analysis confirmed many of the findings from the statistical analysis and was used to triangulate those findings.

CONCLUSIONS

The preceptors largely viewed the preceptorship programme and their role within this programme positively. Although difficulties in making time to meet with preceptees was an issue, the preceptorship experience was perceived to have a positive impact on several aspects of preceptee development as well as on the organisation and on the preceptors' own development. The study is unique when mapped against other research studies because there is little in the literature about studies into preceptors' perceptions of preceptorship programmes.

Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme

AIM

This study aimed to compare rural and urban nurse residency programme participants' personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time.

BACKGROUND

Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses.

METHOD

A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme.

RESULTS

At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar.

CONCLUSIONS

Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration.

IMPLICATIONS FOR NURSING MANAGEMENT

Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy.

Newly qualified nurses--experiences of interaction with members of a community of practice

AIM

To explore newly qualified nurses' (NQN) interaction with members of community of practice (CoP) and how it affects their participation in the CoP.

BACKGROUND

The entry of NQNs into the health care service is problematic which can result in NQNs leaving the profession within the first years of their career. Studies indicate that interaction between NQNs and their colleagues has an important influence of the way in which the NQNs experience their participation in the community of practice.

METHODOLOGY

Nine NQNs participated in the study. The data collection took place six months after graduating and the data were generated by participant observation and individual interview. The data were analysed inspired by Ricoeur's interpretation theory.

RESULTS

Most of the participants expressed satisfaction in their job. They were employed in CoPs characterised by dialogue and with interest in NQNs as a professional as well as a private person. Participants who expressed some dissatisfaction in their job situation were employed in CoPs with less dialogue and with less interest in NQN. Uncertainty about their own capacity and less professional discussions results in NQNs repeatedly asking for specific answer to their questions.

CONCLUSION

Mutual social and professional interest and acceptance increased NQNs' experience of being valued members of the CoP. Higher levels of dialogue and cohesion within the CoP corresponded with more active participation by NQNs and gave them a greater sense of security. Relevance for Clinical Practice NQNs' participation in a COP is influenced by the extent to which they are included in both professional and social interactions and afforded the opportunity to contribute with knowledge and experience from their nursing studies. Furthermore, the study indicates that NQNs' experience of social cohesion within the community appears to increase their professional performance.

Oppression: a concept analysis and implications for nurses and nursing

PURPOSE

To synthesize the literature's discussions on oppression and to explore its implications for nurses and nursing.

SOURCE

Published literature.

CONCLUSION

Oppression requires a set of norms that are determined by a dominant group and a belief of the inferiority of those outside the dominant group. The attributes of oppression are unjust treatment, the denial of rights, and the dehumanizing of individuals. Nurses and the nursing profession both work with oppressed groups and are themselves an oppressed group. By helping their oppressed and vulnerable patients resist the status quo, nurses will begin resisting their own oppressed environment, which will eventually lead to freedom for their patients and themselves.

Family nursing: walking the talk

This article discusses a study exploring the lived experience of family nursing for novice registered nurses. There has been an increased emphasis on including family content in Canadian nursing education curricula. Literature on family nursing is ambiguous about differentiating family nursing at the generalist and specialist level, and acknowledges that there is a blurring of lines between the two. The study utilized a phenomenological approach to examine how nurses with 2 years or less in practice experience family nursing in a variety of settings. Following ethical approval, invitations were sent to all nurses employed in two health authorities, who met the study criteria. Five nurses were interviewed using a semistructured interview. Participants shared how they practice family nursing in the current nursing situation of shortages and constraints. This study adds to our understanding of what happens at a beginning level of family nursing, how nurses understand and experience caring for families in the everyday enactment of their professional role, and barriers and facilitators to including family in nursing care. The findings provide important information for nurse educators in grounding the teaching of family nursing in the real world of nurses.