The experiences of new graduate nurses caring for the deteriorating patient in rural areas: An integrative review

BackgroundWith an ageing population and an increase in chronic conditions, nurses are increasingly providing care for patients with complex healthcare needs who are at risk of deterioration. Although care for the deteriorating patient is expected of nurses, newly graduated registered nurses, being those in their first year of practice since graduation, often feel ill-equipped and unprepared to provide this care and it is unclear as to how working in rural areas may impact the management of care provision.AimThe aim of this review was to identity and explore the literature focused on the experiences of new graduate nurses caring for the deteriorating patient in rural practice areas.MethodsAn integrative review methodology was selected with the aim to review and provide a more comprehensive understanding of New Graduate Registered Nurses (NGRNs) caring for the deteriorating patient by exploring the empirical literature. Literature reviewed was drawn from Australia, the USA, Ireland, Canada, and Sweden. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to present the findings. Literature was critically appraised against the Critical Appraisal Skills Program qualitative studies checklist. Thematic analysis was undertaken to identify relevant themes.FindingsThree major themes were identified within the literature; “preparedness for caring for the deteriorating patient,” “experiencing the deteriorating patient,” and “new graduate support for safe patient care.”DiscussionNGRNs experience stress and anxiety around situations involving the deteriorating patient and are unprepared to manage these. In rural areas NGRNs have additional stressors including increased responsibilities with requirements of everyday care needs and additionally emergent situations, however, the experience of new graduate nurses managing such emergent situations such as deteriorating patients is unknown.ConclusionNo specific studies were found on NGRNs caring for the deteriorating patient in rural areas. Further research is needed to explore the experiences of the newly graduated nurse caring for the deteriorating patient with the added complexities of the rural environment so that appropriate education, orientation, ongoing development and support to ensure safe patient care can be provided.     

New graduate nurses in transition: A review of transition programmes and transition experiences within mental health care

Research on experiences of transition into mental health‐care roles seems sparse, but it is vital in order to produce a comprehensive understanding of the transition into mental health‐care roles and to serve as a foundation for future research and development. The aim of the present study was to review existing research literature, and in doing so, investigate transition programmes for new graduate nurses (NGN) into mental health care, and their experiences of role transition and evaluations of participation in transition programmes. The literature review spans literature published after the year 2000. The literature search was conducted using the following databases: CINAHL, Psychology and Behavioral Sciences Collection, PsycINFO, and Pubmed. Search results consisting of 14 articles were analysed using thematic analysis. Results from the analysis showed four overall themes: nursing education, transition programmes and evaluations, working environment, and the NGN role. We conclude that it is not possible to produce a comprehensive understanding specifically concerning the transition programmes for NGN into mental health care, and that further research is necessary due to the limitations of this review.     

Mental health nursing practice in rural and remote Canada: Insights from a national survey

Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.     

A comparison of the nursing competence of graduates and diplomates from UK nursing programmes

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed.     

Preliminary outcomes of a local residency programme for new graduate registered nurses

kowalski s. & cross c.l. (2010) Journal of Nursing Management 18 , 96–104
Preliminary outcomes of a local residency programme for new graduate registered nurses
Aim  The present study reports preliminary findings regarding new graduate nurses participating in a year-long local residency programme at two hospitals in Las Vegas, NV.
Background  Nurse resident programmes are purported to increase the level of clinical competency and professional transition in new graduate registered nurses (RNs) and to decrease first-year turnover rates. The effectiveness of this programme was assessed using data of the first two cohorts participating in this new residency programme.
Method  Clinical competencies, anxiety, stress, professional transition and retention were measured on 55 nurse residents who have participated in the nurse residency programme.
Results  The findings indicate improved clinical competency throughout the programme, a decreased sense of threat, and improved communication and leadership skills. The first-year cohort's employment retention rate was 78%, and the second-year cohort is presently 96%.
Conclusions  The results of this study demonstrate the positive impact of a year-round residency programme for new graduate RNs.
Implications for nursing management  The need for a consistent nurse workforce demands that new graduates be transitioned into competent practitioners as soon as possible. Nurse residency programmes can provide this support and decrease replacement costs involved in high turnover.     

New graduate nurses' experiences about lack of professional confidence

Professional confidence is an essential trait for new graduate nurses to possess in order to provide quality patient care in today's complex hospital setting. However, many new graduates are entering the workforce without it and this remains to be explored. This study describes how new graduate nurses accounted for their lack of professional confidence upon entry into professional practice and how it developed during their first year of practice in the hospital setting. Two face-to-face, individual interviews of 12 participants were utilized to capture the lived experiences of new graduate nurses to gain an understanding of this phenomenon. After manual content analysis seven themes emerged: communication is huge, making mistakes, disconnect between school and practice, independence, relationship building, positive feedback is important, and gaining experience. The findings indicate that the development of professional confidence is a dynamic process that occurs throughout the first year of practice. New graduate nurses must experience both positive and negative circumstances in order to move toward the attainment of professional confidence. Knowing this, nurse educators in academia as well as in the hospital setting may better support the development of professional confidence both before and during the first year of practice.     

Nursing first year of practice, past, present and future: documenting the journey in New Zealand

Aim  Documenting the journey of graduate nurse support in New Zealand from local programmes to a nationally consistent framework.
Background  Education of nurses in New Zealand has changed over the decades, from apprenticeship-style hospital-based training to academically prepared registered nurses. Newly graduated nurses require time to become confident within the clinical setting. To achieve this, a well-supported graduate nurse programme is required.
Evaluation  The authors utilized historical reviews of nursing education within New Zealand and current work being undertaken by a national working party to implement a nationally consistent graduate nurse programme.
Key issues  Disparity between locally delivered graduate programmes. Lack of funding to provide a well-structured programme and the impact on the recruitment and retention of new nurses.
Conclusions  It was identified that there was a strong need to ensure graduate nurse programmes were consistent across New Zealand in order to support graduate nurses and retain them in the workforce.
Implications for nursing management  The first year of practice remains a challenging transition time with a need for a well-structured and supported programme. Key needs include learning activities grounded in practice experience, robust programme coordination, skilled clinical educators, preceptors, and a structured learning framework.