From university student to registered nurse: the perennial enigma

Cardiovascular Nursing in RN and Higher Education in Swedish Universities: A National Survey

Cardiovascular nursing (CVN) is rapidly developing and has accumulated a large amount of evidence to support interventions aimed at reducing suffering and hastening recovery. However, knowledge of the extent and content of CVN training in Sweden is lacking. The aim of this study was therefore to identify and describe CVN in the Swedish RN education as well as in higher education, with reference to type of course and credits, content, area and target group. A nationwide survey was carried out in Sweden at all university level nursing schools (N=26) by means of a 25-item questionnaire, which was analysed by descriptive statistics. The findings show that 69% and 23% of the schools awarded 0-1 credits [0-1.5 European Credit Transfer and Accumulation System (ECTS)] and 2-3 credits (3-4.5 ECTS), respectively for cardiology/CVN in the RN education. Target areas outside the hospital setting reported by 23% and 19% of nursing schools were primary health care and community care, respectively. Special target groups in addition to the general public were the elderly (42%) and women (58%). Advanced courses in CVN comprising 10-40 credits (15-60 ECTS) were held by 27% of nursing schools, but no school had a specialist or Master level education. Important educational implications from the study of the RN education are the establishment of a minimum credit figure and to reach out into primary health care.

Experiences and learning during a graduate nurse program: an examination using a focus group approach

The graduate nurse year requires individuals to make a huge transition from university student to registered nurse as part of the health care workforce. New graduates experience steep learning curves throughout the first year of professional practice. This study sought to explore experiences and learning occurring throughout the graduate nurse program for a group of seven new nurse graduates. Focus group interviews were conducted at six months and 12 months into the program using the same set of guiding questions. The first interview highlighted that graduates early in the graduate year were internalised, concentrating on their own survival in managing workloads, facing practice realities and coming to terms with themselves as nurses. Learning was primarily about survival strategies and performing tasks. By the second interview, graduates were much less focussed on themselves. They understood their place in the health care team, had gained confidence in their relationships, and were showing concern for the next graduates arriving. Learning at this stage involved more higher order skills, including critical thinking.

Graduates and initial employment

This research project was undertaken to inform nurse educators in the Department of Nursing and Health Studies of Manukau Institute of Technology of the employment opportunities for new graduate nurses emerging from the three year degree and registration programme. The research study aimed to contribute evidence for informed discussion when issues around curriculum development arose, particularly those issues that affect employment success of graduates. A literature review was undertaken of local and international studies and this highlighted a number of studies that examined the experience of new graduates in employment. There was however little evidence that studies had focused on the experiences of graduates as they initially sought employment or their perceptions of how their ability to successfully gain employment was linked to the nursing programme they were exiting from. The data collection tool was a survey consisting of a number of closed questions which required respondents to indicate the option most closely fitting their experience. Analysis of these results was undertaken using SPSS. The last section of the survey invited respondents to comment on any aspect of the focus of the study and qualitative analysis was undertaken of these comments. Graduates from the programme for the previous three years were targeted and names and addresses were available from departmental and institute databases. The research was submitted to the MIT Research and Ethics Committee who stated that the project did not require ethical approval as a retrospective, anonymous survey. 89.8% of graduates across the three years were successful in gaining employment in the first three months post registration. The number of graduates employed within a District Health Board (DHB) declined across the three years but there were no significant differences between cohorts. Overall, 73% of graduates were employed into new graduate positions. The majority of graduates felt that their nursing education prepared them well for their role as a registered nurse. The findings of the qualitative data identified a strong need for science throughout the degree; longer clinical blocks; increased hands on experience; more practice with skills and less theory in relation to practical experience. The results of the study have identified specific information about graduate employment and useful information for the development of a new curriculum.

The nature and implications of support in graduate nurse transition programs: an Australian study

It is widely recognized that support is critical to graduate nurse transition from novice to advanced beginner-level practitioner and to the integration of neophyte practitioners into safe and effective organizational processes. Just what constitutes support, however, and why (if at all) support is important, when, ideally, support should be given, by whom, how, and for how long, have not been systematically investigated. Building on the findings (previously reported) of a year long study that had, as its focus, an exploration and description of processes influencing the successful integration of new graduate nurses into safe and effective organizational processes and systems, the findings presented in this article strongly suggest that support is critical to the process of graduate nurse transition, and that integration into "the system" is best provided during the first 4 weeks of a graduate nurse transition program and thereafter at the beginning of each ward rotation; that "informal teachers" and the graduate nurses themselves are often the best sources of support; and that the most potent barriers to support being provided are the untoward attitudes of staff toward new graduates. Drawing on the overall findings of the study, a new operational definition of support is proposed and recommendations are made for future comparative research on the issue.

Simulator programs for new nurses' orientation: a retention strategy

The phenomenon of role transition for new nurses has been a topic of research and concern for practicing nurses, educators, and administrators for many years. This transition has an impact on the job retention of new nurses. Stress, lack of confidence, and unmet expectations have been found to influence patient safety and outcomes. Simulator programs have enhanced the experiences of students and nurses in the clinical setting. Within this safe environment of simulation, nurses find the opportunity to develop critical thinking, decision making, and clinical confidence. A simulator program was developed in Vassar Brothers Medical Center to assist in the transition of new graduate registered nurses to acute care practice. This article describes the process of developing a program and suggestions for instructors who are interested in developing a simulation program.

Intraprofessional relations in nursing

AIM

This paper is a report of a study to explore the way in which Registered Nurses relate to and interact with each other in the workplace, and to identify factors that influence nurses' interactions with each other.

BACKGROUND

Intraprofessional relations are an important topic both for nurses and nursing as we face the ongoing challenges of nurse shortages. Poor colleague relationships, together with workplace conflict, cause job dissatisfaction. As a consequence, some nurses leave the profession while others continue working but remain chronically unhappy.

METHOD

An explanatory multiple case study design was adopted. Data were collected from multiple sources on three different wards within one hospital in Australia between July 2005 and January 2006.

FINDINGS

The workplace can be a difficult place for both very experienced and less experienced nurses, regardless of the clinical environment. Nurses navigate their way in the workplace through a series of complex negotiations with each other and develop skills to assess the potential success of an interaction before approaching another nurse. Some also develop a resilience to conflict in their workplace, accepting it as part of working life.

CONCLUSION

Creation of a more positive work environment requires increased understanding of the way nurses relate to each other and appreciation of the factors in the environment that contribute to conflict and a negative atmosphere. This appreciation is a necessary prerequisite to developing a more satisfying and productive workplace enhancing the recruitment of new nurses and the retention of experienced nurses.

Processes Influencing the Development of Graduate Nurse Capabilities in Clinical Risk Management

OBJECTIVES

To explore and describe key processes influencing the development of graduate nurse capabilities in clinical risk management (CRM).

METHODS

This study was undertaken using an exploratory descriptive case study method. Four sample units of analysis were used, notably: 2 cohorts of graduate nurses (n = 11) undertaking a 12-month graduate nurse transition program; key stakeholders (n = 34), that is, nurse unit managers, clinical teachers, preceptors, a quality manager, a librarian, and senior nurse administrators employed by the participating health service; patient outcome data; and pertinent literature.

RESULTS

Data strongly suggested that graduate nurse capabilities in CRM were most influenced not by their supposed lack of clinical knowledge and skills but by their lack of corporate knowledge. The failure to provide new graduate nurses with pertinent information on CRM at the beginning of their employment and thereafter at pertinent intervals during the graduate nurse year program aslo hindered the development of their capabilities to manage clinical risk.

CONCLUSIONS

Management and educational processes pertinent to informing and involving new graduate nurses in a hospital's local CRM program (including information about the organization's local policies and procedures) need to be implemented systematically at the very beginning of a new graduate's employment and thereafter throughout the remainder of the graduate nurse year.

Doing Phenomenological Research Collaboratively

Collaborative research between nurses employed in the academic and practice sectors is a cost-effective and innovative way to investigate aspects of clinical practice, articulate clinical and teaching expertise, and extend professional practice knowledge. In collaborative ventures, researchers from different institutional cultures often work together to investigate a particular area of interest. This poses challenges in relation to the perceptions, understandings, and interpretations of the research question and of the mode of inquiry, particularly when investigating through the qualitative paradigm. The purpose of this article is twofold. The first is to clarify some of the challenges experienced while conducting collaborative research and describe the steps taken to ensure consistency between the purpose of the research and the phenomenological research design used to explore the learning that nursing students acquire in their final clinical practicum. Second, it was thought that by illuminating this learning, registered nurses working as preceptors and those supporting new graduates could gain insight into the complexities of learning the skills of safe and competent practice from the student's perspective. This insight is essential in creating a strategy between education and practice to minimize the duplication of learning opportunities and lessen the cost of supporting newly registered nurses, which may be at the expense of investment in the professional development of experienced registered nurses.

Adequacy of support for new graduates during their transition into the workplace: A Queensland, Australia study

In 2001, a study into issues of concern to assistant-in-nursing, registered and enrolled nurse members of the Queensland Nurses Union was undertaken. Approximately equal numbers of nurses from each of the aged care, acute private and acute public sectors were surveyed. Overall, 1477 nurses responded, representing a response rate of 53%. This article focuses on one aspect of the study-the perceived adequacy of support offered to new nursing graduates as they exit university and begin their transition into the workplace. In particular, responses from nurses are compared with professional level or current role designation, age, time spent in the workplace and health sector. Considerable divergence of opinion among the respondents, particularly across designation, age and years of experience, was found within the three sectors. For example, in the public and private employment sectors, older and more experienced nurses were more likely to perceive the support for new nurses as adequate compared to younger and less experienced nurses. Additionally, in the acute private sector, the more senior the nurse the more likely the perception that there was adequate preparation for new graduates entering the workforce.

The scope of nursing in Australia: a snapshot of the challenges and skills needed

Contemporary nursing is an increasingly complex concept encompassing and encapsulating wide variation under the broad rubric of the nursing work place. This paper reports on a study that was designed to contribute to understandings of nursing practice by describing what nurses in Australia are doing everyday in various practice and work settings, the type of skills they need, the challenges they face and the interactions nurses have with other health workers. Drawing on the research which informed the National Review of Nurse Education in Australia in 2001, the paper raises issues critical to the management of contemporary nursing practice. Flexible approaches both to the day-to-day management of nurses and nursing, and educational preparation in partnership with key stakeholders, are a necessity if management of nursing is to keep pace with constant change in health care systems as well as facilitating the attraction and retention of nurses in those systems.

Expectations and perceptions of graduates' performance at the start and at the end of their graduate year

This descriptive study reports on the expectations and perceptions of graduate performance by graduates themselves, their preceptors, and their clinical nurse consultants (CNCs) at the commencement of employment as a beginning level registered nurse, and near the end of graduates' twelve months of professional employment. Findings indicate that graduates expected to be functioning at a higher level of performance at the beginning of their graduate year than did the preceptors and CNCs. There was little agreement between the three groups regarding the rating of their expectations of graduates' nursing performance. When agreement between pairs of groups was examined, preceptors and CNCs agreed most, followed by graduates and preceptors, and graduates and CNCs. When perceptions of graduates' performance were compared near the end of the graduates' employment period, graduates rated their own nursing performance higher than preceptors and CNCs. Once again there was little agreement among the three groups. Overall, graduates and preceptors agreed most. On the basis of these results the question is begged, on what basis is the decision taken to terminate preceptorship support for graduates?

Undergraduate student nurses' expectations and their self-reported preparedness for the graduate year role

AIMS OF THE STUDY

The study identifies third-year nurses' expectations of the graduate nurse role and ascertains how prepared they feel to fulfil this role.

BACKGROUND

The literature substantiates that the university-workplace transition is marked by differences between students' expectations of the graduate year and the realities of practice they encounter in the workforce setting. Nursing professionals and health service employers continue to debate the expectations required of the new nurse graduate. Yet there is little assessment of graduate nurses' expectations of the workplace. This study describes student nurses' expectations of the graduate year and the extent to which they regard themselves as well- or ill-prepared.

DESIGN

Third-year student nurses (n=105) from a 3-year Bachelor of Nursing (BN) course at a large Metropolitan University in Australia were surveyed. A group of nursing academics and their senior colleagues in the clinical setting designed a questionnaire in light of common themes derived from literature on the graduate year role. Responses were examined and analysed using descriptive statistics.

RESULTS

Responses revealed that student nurses tended to favour large public hospitals, and sought a good graduate programme with associated opportunities for guidance and support. Most expected to achieve good working relationships with both professional colleagues and patients. Final year students expressed some apprehension about meeting the performance expectations of the workplace, given their self-perceived lack of clinical experience.

CONCLUSION

When asked about their initial expectations of the workplace, third year student nurses expressed little apprehension and reported high levels on scales of organizational commitment and professionalism. The research literature suggests that divisions exist between students' expectations of the graduate year and the actual work experience. The expectations of the graduate year described in this study offer a student-centred perspective that contributes to future planning and policy directions of undergraduate curricula, graduate year programmes and nurse retention.

Evaluating preceptorship arrangements in a paediatric setting

Preceptorship can be a valuable support mechanism for newly qualified nurses. Both preceptors and preceptees need support to ensure effective preceptorship arrangements. Maintaining effective preceptorship arrangements can be challenging for preceptees, preceptors and the organisation. Further research is required to explore the full potential of preceptorship.

The development of an evaluation tool for grading clinical competence

A perceived difficulty in grading clinical practice has meant that over the past two decades, educators in nursing have focused on non-graded results for clinical practicum. However, students expect rewards for achievement. Hospitals and universities require a means of differentiating levels of performance for employment and further study. This exploratory study uses quantitative and qualitative methods to evaluate a tool for grading clinical competence. The aims of the study were to determine the distribution of clinical grades, compare the clinical grades with the cumulative theoretical grades and compare the clinicians' and students' perceptions of competence. Study findings show that students and clinicians rated clinical performance well above the expected level. These grades for clinical performance exceeded comparative results in theoretical work for the practicum topic. In addition, content analysis of the qualitative data indicates that clinicians may have difficulty in using the ANCI Competencies to rate a student's performance for registration as a nurse.