Entry into nursing: an ethnographic study of newly qualified nurses taking on the nursing role in a hospital setting

Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help

AIMS

To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention.

DESIGN

Qualitative descriptive design.

METHODS

Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi-structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018-2020. Data were analyzed using thematic analysis and an essentialist, bottom-up approach.

RESULTS

Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering.

CONCLUSIONS

This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce.

IMPACT

Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Professional Socialization of Nurses in Humanized Care: A Qualitative Study

Background

Professional socialization of nurses is the process of transferring knowledge, skills, techniques, attitudes, and values among nursing professionals in order to enhance their capacity consistently. The objective of this research was to study the professional socialization of nurses in humanized care in 2 phases: in a nursing study phase, and in a nursing professional phase.

Materials and Methods

The study was implemented in the form of a qualitative study by using an in-depth interview technique for the data collection. The informants of the study were 12 professional nurses who were granted the Award of Ratchaphiphat Role Model of Best Moral Practice.

Results

During the nursing study phase, it was found that the professional socialization of nurses operated through course content, teaching management, extra-curricular activities, the interaction between nursing instructors and students, interaction among peers, observation of nursing instructors, and observation of nurses. On the other hand, in the nursing professional phase, professional socialization is performed through orientation, on-the-job training, supervision, ethical and moral promoting activities, and interaction with and observation of colleagues.

Conclusions

Based on the findings, some recommendations were proposed as guidelines to develop nursing educational management for promoting humanized care in the development of nursing students and professionals.

Development and Validation of a Chinese Version of a School-to-Work Transition Anxiety Scale for Healthcare Students

OBJECTIVE

The aim of this paper was to develop an appropriate scale measuring healthcare students' anxiety during the transition from school to work.

METHODS

After an extensive literature review and panel discussion to prove the face validity and content validity, the initial item pool was reduced to 52 items. In a pilot study, a sample of four hundred and twenty-four healthcare students participated, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. Psychometric properties-construct validity, convergent validity, discriminant validity, goodness of fit, and reliabilities-were also analyzed.

RESULTS

After the use of EFA, the 52 items were reduced to 31 items in four factors, with 66.70% of the total variance explained. The Cronbach's alpha values ranged between 0.91 and 0.93. The study also used CFA to validate the EFA model, and the results demonstrated that with the same thirty-one items in a 7-point Likert scale, the model was a better fit in four factors: "inexperience in professional knowledge and skills" (nine items; factor loadings: 0.642-0.867; 43.72% of the variance explained), "fear of death" (eight items; factor loadings: 0.745-0.831; 9.94% of the variance explained), "fear of being infected" (eight items; factor loadings: 0.678-0.866; 7.86% of the variance explained), and "interpersonal interactions" (six items; factor loadings: 0.704-0.913; 5.18% of the variance explained). The CFA model demonstrated a good model fit in the χ²/df ratio (1.17; p = 0.016), CFI (0.99), TFI (0.99), and RMSEA (0.02). The composite reliabilities ranged from 0.89 to 0.92, confirming the StWTA-HS scale's stability and internal consistency. The convergent validity and discriminant validity were also confirmed. The StWTA-HS scale has been proven to be a stable scale to measure healthcare students' school-to-work transition anxiety.

Nursing Education: Students' Narratives of Moral Distress in Clinical Practice

BACKGROUND

Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a "reality shock". This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice.

METHODS

Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings.

RESULTS

A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care.

CONCLUSION

Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.

Exploring newly qualified nurses' experiences of support and perceptions of peer support online: A qualitative study

AIMS AND OBJECTIVES

To explore newly qualified nurses' support needs and their perceptions of online peer support.

BACKGROUND

The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well-being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses' emotional and social well-being.

DESIGN

A qualitative exploratory study was designed, employing semi-structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist.

METHODS

Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018-January 2019.

FINDINGS

Two main themes arose. The first was Drowning, a lot of the time with two sub-themes: (i) Feelings and emotions about being a Newly Qualified Nurse: 'Absolutely terrified' and (ii) Support within the role: 'Somebody you can count on'. The second was Potential advantages and disadvantages of online modality: 'Somebody is going to get in that phone!' which included three sub-themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations.

CONCLUSIONS

This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses' well-being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID-19 pandemic.

Development and validation of a new instrument to measure nursing students compassion strengths: The Bolton Compassion Strengths Indicators

Despite considerable research and rhetoric on the importance of compassion in nursing, progress has been hindered by the lack of an adequate psychometric instrument to measure its multidimensional nature. This paper reports several studies conducted over three stages, to develop and validate a new instrument to measure nurses' compassion strengths. A purposive sample of UK pre-registered nursing students studying at a University took part in this study. The eight indicators highlight the multidimensional nature of compassion. The Bolton Compassion Strengths Indicators (BCSIs) demonstrated robust psychometric properties and could provide the means by which nursing students can empower themselves, as they strive to develop their professional identity as compassionate practitioners. This new measure will also help other researchers and educators who wish to study the development of compassion strengths in nursing.

Undergraduate nursing student perceptions of directed self-guidance in a learning laboratory: An educational strategy to enhance confidence and workplace readiness

A self-directed learning laboratory (SDL Lab) was established in which undergraduate nursing students were provided access to experienced nurses in a simulated ward environment to enhance preparedness for clinical practice. The aim of this study was to explore perspectives of final year, undergraduate student nurses about the SDL Lab and directed self-guidance, with particular focus on the impact on learning and preparedness for professional practice. The study was framed within a qualitative descriptive approach using semi-structured, digitally recorded face-to-face interviews. The purposive sample included undergraduate students enrolled in their final year of a Bachelor of Nursing program, who had accessed the SDL Lab on at least two occasions. Thematic analysis was used. Twelve students participated. Three main themes were identified: 1) A safe environment that fosters effective learning; 2) Directed self-guidance strengthens confidence and competence during workplace experiences; 3) Enhancing accessibility and realism will improve learning. Reports of increased confidence in performing nursing skills was found in this study. Evaluation of the SDL Lab found that this alternative teaching strategy was favourable, and students appreciated the safe learning environment. Future research might explore measurement of the effect of directed self-guidance in an SDL facility on competence and confidence.

The experience of transition from nursing students to newly graduated registered nurses in Singapore

Objectives

To investigate the experience of newly graduated registered nurses (NGRNs) in Singapore following their initial 6–12 months of transition from nursing student to registered nurse.

Methods

This mixed-methods study consisted of two phases. In the first phase, data were collected via the administration of the online survey to 30 NGRNs. The questionnaire contained 42 items of the four-point Likert scale survey. In the second phase, a focus group interview was conducted with 5 NGRNs to gather complementary information regarding the major findings from the first phase.

Results

The survey revealed despite most NGRNs (80%) in this study expressed overall satisfied with their transition, the item score was (2.97±0.61) out of 4, the majority (83.3%) also perceived their transition to professional practice being stressful, the item score was (3.07±0.74) out of 4.Three themes emerged from the interview, ‘personal transition experience’, ‘professional transition experience’, and ‘organizational transition experience’, which are entwined to construct overall NGRNs’ transition experiences.

Conclusions

This study reaffirms the theory-practice gap phenomenon. This signifies the need for closer collaboration between educational, healthcare industry and regulatory stakeholders to examine and address factors that influence their transition experience to better support them for workforce readiness.

"Theory Becoming Alive": The Learning Transition Process of Newly Graduated Nurses in Canada

BACKGROUND

Newly graduated nurses often encounter a gap between theory and practice in clinical settings. Although this has been the focus of considerable research, little is known about the learning transition process.

PURPOSE

The purpose of this study was to explore the experiences of newly graduated nurses in acute healthcare settings within Canada. This study was conducted to gain a greater understanding of the experiences and challenges faced by graduates.

METHODS

Grounded theory method was utilized with a sample of 14 registered nurses who were employed in acute-care settings. Data were collected using in-depth interviews. Constant comparative analysis was used to analyze data.

RESULTS

Findings revealed a core category, "Theory Becoming Alive," and four supporting categories: Entry into Practice, Immersion, Committing, and Evolving. Theory Becoming Alive described the process of new graduate nurses' clinical learning experiences as well as the challenges that they encountered in clinical settings after graduating.

CONCLUSIONS

This research provides a greater understanding of learning process of new graduate nurses in Canada. It highlights the importance of providing supportive environments to assist new graduate nurses to develop confidence as independent registered nurses in clinical areas. Future research directions as well as supportive educational strategies are described.

A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses

BACKGROUND

Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.

AIM

To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.

METHOD

Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout.

PARTICIPANTS

A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.

RESULTS

Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout.

CONCLUSION

High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.

Perceptions of newly-qualified nurses performing compulsory community service in KwaZulu-Natal

BACKGROUND

Compulsory community service (CCS) for nurses commenced in South African January 2008 after it was legislated in the new Nursing Act (Act No. 33 of 2005). Nurses completing their registered nurse programme are registered as community nurse practitioners (CNPs) during the CCS period and make up the largest number of health professionals serving CCS. Whilst health institutions have welcomed CNPs as additional resources for the shortage of nursing staff, no structured guidelines have been provided at a regional level as to how these nurses should be utilised or managed during the CCS year. To date, no large-scale study has been conducted on nurses carrying out CCS in order to generalise the findings.

OBJECTIVES

To establish the perceptions of newly-qualified nurses carrying out CCS in KwaZulu-Natal, South Africa.

METHOD

A quantitative survey design was used to obtain data from a randomly selected sample of the 2012 cohort of nurses carrying out CCS in KwaZulu-Natal.

RESULTS

CNPs have a positive attitude toward CCS and perceive themselves as being well prepared for the year of community service in terms of knowledge, skills and ability to administer nursing care. They identified positive benefits of the year of community service.The concerns raised were limited orientation and support; and a few CNPs experienced problems of acceptance by the nurses with whom they work.

CONCLUSION

It is recommended that all health institutions who receive CNPs develop structured orientation and support for these nurses in order to promote their development, thereby enhancing their benefit to the communities they serve.

The design of compassionate care

AIMS AND OBJECTIVES

To investigate the tension between individual and organisational responses to contemporary demands for compassionate interactions in health care.

BACKGROUND

Health care is often said to need more compassion among its practitioners. However, this represents a rather simplistic view of the issue, situating the problem with individual practitioners rather than focusing on the overall design of care and healthcare organisations, which have often adopted a production-line approach.

DESIGN

This is a position paper informed by a narrative literature review.

METHODS

A search of the PubMed, Science Direct and CINAHL databases for the terms compassion, care and design was conducted in the research literature published from 2000 through to mid-2013.

RESULTS

There is a relatively large literature on compassion in health care, where authors discuss the value of imbuing a variety of aspects of health services with compassion including nurses, other practitioners and, ultimately, among patients. This contrasts with the rather limited attention that compassionate practice has received in healthcare curricula and the lack of attention to how compassion is informed by organisational structures and processes. We discuss how making the clinic more welcoming for patients and promoting bidirectional compassion and compassion formation in nursing education can be part of an overall approach to the design of compassionate care.

CONCLUSIONS

We discuss a number of ways in which compassion can be enhanced through training, educational and organisational design, through exploiting the potential of brief opportunities for communication and through initiatives involving patients and service users, as well as practitioners and service leaders.

RELEVANCE TO CLINICAL PRACTICE

The development of contemporary healthcare systems could usefully address the overall design of compassionate care rather than blame individual practitioners for a lack of compassion.

A Narrative Exploration

Experienced nurses are repeatedly asked to mentor and to work with new graduate nurses in intensely busy hospital environments. To gain an understanding of experienced nurses’ perspectives of working with new graduates, eight nurses were interviewed from two hospitals in Eastern Canada. Narrative analysis revealed that experienced nurses prepared in advance for new graduates’ arrival and felt their workload increased when new graduates actually began to practice. Experienced nurses expressed verbal support for new graduates and yet their stories did not all reflect supportive comments. Themes identified were New Graduates Are Coming, Keeping Us on Our Toes, and Carrying the Load. Findings provide valuable information to help nurses, educators, and managers gain a new understanding of what it is like for experienced nurses working with new graduates. There are important implications for managers in how to support experienced nurses as they work alongside new nurses.