The experience of new nurses’ early working life: Learning in a hospital care context – An interview study

AimTo explore how nurses during their early working life learn to provide high-quality care in relation to organisational prerequisites in a hospital setting.BackgroundWhen nurses enter employment in contemporary hospital settings, they face multiple learning challenges. Organisational prerequisites that have been identified to affect their ability to learn to provide high-quality care are related to staffing turnovers, large patient groups and a lack of experienced staff to support their learning.DesignQualitative.MethodsThe study was conducted between 2018 and 2019 at a medium-sized hospital in Sweden. Data from interviews with 10 nurses with fewer than two years’ work experience were subjected to qualitative content analysis.ResultsThe results describe the nurses’ learning during their early working life in two categories: Performing tasks in relation to organisational prerequisites and Making use of clinical experiences to grasp the complexity of nursing care. The first theme reflected a learning process that was initially characterised by seeking confirmation and instructions from colleagues of how to act safely and by balancing the demands of time efficiency and sustaining patient safety. The second theme reflected that, after addressing organisational prerequisites, the nurses tried to understand and make use of clinical experiences to grasp the complexity of nursing care by encountering and processing clinical patient situations.ConclusionsThe results of this study revealed that nurses’ learning during early working life seemed to be primarily directed towards handling tasks, with sometimes limited opportunities to grasp the complexity of nursing care. Their learning depended largely on their own initiative and motivation and was strongly influenced by organisational prerequisites. The limited availability of experienced nurse colleagues and lack of time devoted for reflection needs to be dealt with to support nurses’ learning.     

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review

IntroductionThe number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.ObjectivesTo examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.Review MethodsA comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.Data sourcesThe following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.ResultsRigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,⁷¹ a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,⁷² and the Mixed Methods Appraisal Tool for mixed-method studies.⁷³ The critical review guidelines by Shenton⁷⁴ and Polit and Beck⁷⁵ were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; ‘1) building professional relationships’, ‘2) leading the way’ and ‘3) satisfying the needs of ICU nurses’.ConclusionNurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.     

Feasibility of supporting newly qualified nurses: Nominal group technique of the perspectives of nursing stakeholders

BackgroundAs the health industry grows, integration of newly qualified nurses into the workplace is critical to workforce sustainability. In one health service, a work-based student learning program, the Collaborative Clusters Education Model, was extended to support newly qualified nurses in their transition to the workplace.AimTo describe the feasibility of the Collaborative Clusters Education Model to support newly qualified nurses.DesignEvaluative methodology using Nominal Group Technique.MethodsConvenience and snowball sampling were used to recruit participants from three stakeholder groups: clinical nurse facilitators (two groups: n1 = 7; n2 = 5), nurse leaders (n = 9) and practice partners, registered nurses who support with newly qualified nurses (n = 5). Groups provided nominal rankings of ideas (quantitative data) and group discussions were recorded and professionally transcribed (qualitative data). Data analysis involved three stages: i) quantitative analysis; ii) qualitative analysis and iii) synthesising qualitative and quantitative data to create meaning.ResultsThe priorities focused broadly on the challenges associated with individual and organisational capacity to support newly qualified nurses. In addition to capacity, clinical facilitator capability, teamwork and communication, and role ambiguity were identified as key issues.ConclusionsThe feasibility of supporting newly qualified nurses via the Collaborative Clusters Education Model would be enhanced with improved alignment between stakeholder roles and responsibilities. In contemporary workplaces, characterised by distributed responsibility for learning support, there is a need for increased role clarity across the stakeholder team. Furthermore, the need for improved access to experienced mentors points to the potential of team-based models of nursing care delivery.     

Investigating the impact of a psychoanalytic nursing development group within an adolescent psychiatric intensive care unit (PICU)

ObjectiveTo evaluate the impact of an adapted psychoanalytic work discussion group for mental health nurses working in adolescent PICU.BackgroundThere is no prior research investigating interventions that effectively support and enable adolescent PICU nursing teams to sustain the therapeutic tasks of their work and their own sense of wellbeing.MethodsA bespoke psychoanalytic work discussion group was implemented within an adolescent PICU. Data was collected using in-depth semi-structured interviews with participants, about the impact of the group upon their practice. Data analysis used thematic analysis.ResultsThe group positively impacted upon participant knowledge and understanding, emotion management, personal efficacy, therapeutic relationship building, managing challenging behaviour, leadership, professional identity and team cohesion.ConclusionMechanisms by which these outcomes were achieved are elaborated utilising the concepts of projective identification, emotional containment and ‘temporary outsider-ship’. There is a need to account for the interplay between adolescent defense mechanisms, nursing anxieties and setting-specific organisational dynamics, in the design of effective support interventions for adolescent mental health nurses.     

Nurses’ experiences of working in organizations undergoing restructuring: A metasynthesis of qualitative research studies

BackgroundHealth care organizations worldwide undergo continual reconfiguration and structural changes in order to optimize the use of resources, reduce costs, and improve the quality of treatment.ObjectiveThe objective of this study was to synthesize qualitative studies of how nurses experience working in organizations undergoing structural changes.DesignThe review is designed as a metasynthesis and follows the guidelines put forth by Sandelowski and Barroso for synthesizing qualitative research.Data sourcesFrom January to April 2015, literature searches were conducted in the CINAHL, PubMed, ProQuest, and Web of Science databases for the period from 1994 to 2014.Review methodsA total of 762 articles were found and screened, 12 of which were included in the review after being appraised using a specially designed reading guide. The inclusion criteria were qualitative studies in English, German, Norwegian, Swedish, or Danish on nurses’ experiences with being employed in organizations undergoing structural changes. The data were then analyzed in a metasummary and metasynthesis.ResultsFour overall categories that illustrate how nurses experience working in organizations undergoing structural changes were identified: nursing management, emotional responses, nursing work, and colleagues. Generally, nurses seemed to describe their experiences working in organizations undergoing structural changes in a negative way, as all of the included articles reported that nurses experience an increased workload due to restructuring. However, some of the articles reported that nurses also experience a certain joy associated with the nursing work despite the negative consequences of the structural changes.ConclusionsThe findings can be seen as a paradox because former research has shown that an increased workload reduces the pleasure in working. Further research on this topic is needed to ensure a better working environment for nurses.     

Novice nurses’ experiences from teamwork in the emergency department: A qualitative content analysis

Background and aimTeamwork is assumed crucial in nursing. Nevertheless, nursing shortages in medical centers have thus far compelled nurse managers to use novice nurses. The present study aimd to explaining the challenges and experiences of novice nurses regarding teamwork in emergency departments.Materials and methodsUsing qualitative content analysis, 11 novice nurses working at emergency department, participated in this study. Data were collected with semi structured interview and analyzed by Graneheim and Lundman.ResultsThe data analysis led to the emergence of four themes of “essential teamwork skills development”, “contradictory relationships between team members”, “unpleasant feelings and experiences”, and, “personal growth and maturation during teamwork”.ConclusionFostering different personal aspects as prerequisites for teamwork, novice nurses will be able to deal with unpleasant feelings and experiences as well as contradictory relationships between team members in an effective manner. This challenging experience will thus give rise to personal growth and maturation during teamwork among them in emergency department.     

The role of the intensive care nurse in the medical emergency team: A constructivist grounded theory study

BackgroundIntensive care nurses are essential members of rapid response systems (RRSs) with little qualitative data available to capture what intensive care nurses do as they navigate their way around the complexity of a medical emergency call.ObjectiveThe study aims to describe and explain the role of the intensive care nurse within the medical emergency team (MET) of a tertiary-level hospital to develop an understanding of the intensive care nurse role, the way it is enacted, and their responsibilities within the team.MethodA constructivist grounded theory research approach collected qualitative data from intensive care nurses who had experience attending MET calls. Data were collected through participant observation (16 MET calls), followed by 12 semistructured interviews.FindingsA substantive theory was developed that ‘keeping patient's safe’ is a fundamental role of the intensive care nurse within the MET. This is derived from four key concepts: Systematic framework for decision making, Figuring it out, Directing care, and Patient safety. Each of these concepts was developed from categories that describe the role of the intensive care unit nurse on the MET. They include performing assessments and interventions, figuring it out, critical thinking, prioritising care, directing care, being supportive, and ensuring patient safety.ConclusionThis study provides new insights into and an understanding of the ways intensive care nurses work within the MET, making a significant contribution to our existing understanding of the role.     

Newly qualified graduate nurses’ experiences of workplace incivility in healthcare settings: An integrative review.

AimTo explore, identify and integrate the existing knowledge to categorise the characteristics, likelihood, and consequences of workplace incivility among newly qualified graduate registered nurses. A particular focus of this review is on the experiences of new nurses related to these negative workplace behaviours and the strategies employed by these nurses and their organisations to manage workplace incivility.BackgroundWorkplace incivility has been widely recognised as a global problem in healthcare settings and is known to affect nurses in all facets of their professional and personal life. This might be particularly harmful for newly qualified graduate nurses, as they are unprepared to deal with this uncivil culture.DesignAn integrative review of the global literature, conducted according to the Whittemore and Knafl framework.MethodsDatabase searches (CINAHL, OVID Medline, PubMed, Scopus, Ovid Emcare and PsycINFO), and manual searching generated an aggregate of 1904 articles, which were further screened based on inclusion criteria and eligibility using the Mixed Methods Appraisal Tool (MMAT). Peer-reviewed empirical studies that explored the workplace incivility experiences of new graduate nurses were included in this review. Extracted data were grouped to develop themes and sub-themes.ResultsThis review included 14 studies in total with seven quantitative and seven qualitative studies. The data collected from these studies were categorised according to the research questions into a) expectations of civility, b) experiences and exposure to workplace incivility, c) forms and characteristics of incivility, d) sources of incivility, e) consequences of incivility, and f) managing and coping with incivility. Across studies, graduate nurses' views about the prestige and power of the nursing profession are conflicted due to experiences of incivility in clinical practice. New graduate nurses experienced a high but variable prevalence of incivility from their co-workers (25.6–87 %), with manifestations of incivility varying greatly, including eye rolling, yelling, exclusion and sexual harassment. Included studies primarily focused on professional and organisational effects and their outcomes relative to the physical and psychological effects on new nurses.ConclusionFindings from the literature demonstrate that incivility directed toward newly qualified graduate nurses is prevalent and can have significant negative impact on their self-esteem and confidence, which may ultimately impact on their workforce participation decisions and the quality of patient care. Supportive and empowering work environments are vital not only for improved nurse health and well-being, but also to retain new graduate nurses. The current nursing shortage emphasises the need for such conditions.     

Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study

BackgroundThe international nursing shortage has implications for the quality and safety of patient care. Various studies report that nurses do not have time to complete all necessary nursing care tasks, potentially resulting in nurse-perceived time pressure. Providing good care in the current nursing environment often poses a real ethical challenge for nurses. How nurses experience caring for cancer patients under time pressure and how they deal with the limited time available in achieving an ethical nursing practice remains unclear.ObjectivesTo report qualitative research grounded in oncology nurses’ experiences with time pressure, its perceived impact on nursing care and the ways in which they deal with it.DesignA qualitative study design with a grounded theory approach was conducted to explore and explain oncology nurses’ experiences with time pressure and its underlying dynamics.Setting and participantsPurposive and theoretical sampling led to the inclusion of 14 nurses with diverse characteristics from five inpatient oncology nursing wards in one academic hospital.MethodsIndividual, semi-structured, in-depth interviews were conducted over a six-month period in 2015 and 2016. Data collection and analysis occurred simultaneously. The interview data was analysed using the Qualitative Analysis Guide of Leuven and NVivo software.ResultsThe conceptualised phenomenon of time pressure, grounded in empirical data, illuminated its complexity and helped us to explicate and describe what nurses felt when working under time pressure. The interviewed nurses described time pressure as a shared yet nuanced reality. We uncovered that nurses dealt with time pressure in varied ways, with a broad range of proactive and ‘ad hoc’ strategies. According to our interviewees, time pressure was a significant barrier in providing good nursing care. They illustrated how time pressure particularly affected the interactional aspects of care, which most nurses considered as essential in an oncology setting. Underlying personal, cultural and context-related factors seemed to play a key role in nurses’ individual experiences with time pressure.ConclusionTime pressure is a widely recognised and experienced phenomenon among nurses which has substantial negative implications for the quality and safety of patient care. Our findings reinforce the need to establish better support for nurses and to reduce the circumstances in which nurses are ethically challenged to provide good care due to time pressure. Based on our findings, we recommend investing more in the nursing culture and nurses’ personal development, in addition to optimising nurse staffing levels.     

Nurses’ perspectives on responding to elder abuse in a hospital setting

BackgroundNurses caring for hospitalised older people are well situated to identify and respond to elder abuse. However, little is known about how nurses working in acute and subacute care recognise and respond to suspected abuse.AimThe project team aimed to explore how nurses detect, assess and respond to elder abuse as part of a quality improvement activity to develop a model of care to address elder abuse.MethodFocus group interviews were conducted with ward nurses and nurse educators (n = 19) working in both acute and subacute care settings in a tertiary teaching hospital. Transcribed interviews were coded and analysed thematically.FindingsPrimary themes identified included: perceived flags for elder abuse; the importance of relationship building to elicit disclosures; the challenges involved in substantiating abuse; and dealing with uncertain outcomes.DiscussionDifficulties encountered in substantiating abuse were often compounded by organisational factors and time constraints. Having the time to build a relationship with the older person enabled a more comprehensive assessment of risk factors, but for those working in fast-paced wards this was not always possible.ConclusionEffective responses to elder abuse require an organisational culture that recognises the importance of a relationship-based model of care.     

The impact of a three-tiered model of nursing redeployment during the COVID-19 pandemic: A cross-sectional study

ObjectiveThe COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units. We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in intensive care units during the COVID-19 pandemic.MethodologyIn this cross-sectional study, 931 nurses (464 intensive care and 467 redeployed nurses) who worked within four adult units in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid unit orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire.ResultsA total of 191 survey responses were retained (59 intensive care nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, intensive care unit, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent intensive care nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models.ConclusionNurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and intensive care nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward.Implications for clinical practiceTargeted strategies are required to support education, role transition, and optimize competency and role clarity during nursing redeployment for overcapacity surge. Essential strategies to support redeployed nurses include individualized competency assessments pre-redeployment and prior to role transitions, pairing redeployed nurses with the same intensive care nurse consistently, and availability of a nurse educator or resource for additional just-in-time training supports. Contingency disaster strategies should also include interventions targeting staff wellness and prevention of burnout, as well as identify scenarios in which redeployment may increase risks of psychological harm. Debriefing and peer-to-peer support models may increase the efficiency of psychological support for nurses, though additional research is required. Lastly, given enaction of tiered models of nursing care is largely a novel occurrence in the intensive care unit, leadership training is required to support frontline nurses taking on supervisory roles within these team models.     

Nurse turnover: a literature review - an update

BackgroundConcerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations.ObjectivesThe objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies.DesignA comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years.Data sourcesElectronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications.Review methodsKeyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies.ResultsFrom about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations.ConclusionsNursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.     

A mixed method study to determine the attitude of Australian emergency health professionals towards patients who present with deliberate self-poisoning

IntroductionDeliberate self-poisoning is one of the frequent presentation types to emergency departments. It has been reported that attitudes of emergency staff may have negative consequences for the wellbeing of the self-poisoning patient.AimDetermine the attitude of nursing and medical staff towards patients who present with deliberate self-poisoning and to identify if differences exist between the two groups.DesignMixed-method.MethodologyThe “Attitudes towards Deliberate Self-Harm Questionnaire” was distributed to all nursing and medical staff who had direct patient contact at three emergency departments (N = 410). Total and factor scores were generated and analysed against variables age, gender, length of experience working in the emergency department, level of education and by profession. Two open ended questions asked staff to write their perceptions and stories about patients who deliberate self-poison and were analysed using qualitative data analysis.ResultsForty-five percent of staff returned the questionnaire. The attitude of emergency nurses and doctors was positive towards patients who deliberately self-poison. Doctors had significantly higher total and Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ scores than nurses. After adjusting for length of time working in the emergency department only Factor 2 ‘dealing effectively with the deliberate self-poisoning patient’ remained statistically significant. Staff reported high levels of frustration, in particular to patients who represent.Conclusion/relevance to practiceThis information may be used to develop and implement educational strategies for staff to improve the experiences of and better support patients presenting to the emergency department who deliberately self-poison.     

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.