Implementing a Hospital-based Radiology Nursing Orientation Program for New Graduate Pediatric Nurses

Recruitment and retention in the unique and immensely growing field of radiology nursing is challenging as the nursing role evolves in response to advanced imaging and sedation procedures. At Children's National Medical Center, the radiology nursing team was confronted with recruiting enough nurses to respond to the rapid expansion of its radiology department. The department was preparing to open a new magnetic resonance imaging suite with three new magnetic resonance imaging scanners and additional anesthesiologist support for sedation, which would result in increased patient volumes and a need for more nurses. In 2010, the radiology nursing department chose to develop a program for new graduate nurses to acquire the skill set needed for radiology nursing while meeting the needs of the expanded services. In this article, we report the process and outcomes of structuring a 12-week comprehensive New Graduate Nurse Orientation Program that met the professional development needs of novice nurses and the specialty's need to produce competent radiology nurses. Through the curriculum and as documented in self- and preceptor evaluations, the orientation program's success was measured by 100% retention of the new graduates, positive self-assessments and continued involvement in the nursing profession. Implementing a quality orientation program for new graduate nurses resulted in a positive transition into their first year of practice. This program not only developed four new nurses in the field of radiology nursing, but it also engaged the experienced clinical nurse in supporting and mentoring the novice nurse.     

Implementation of medical-surgical nurse extern and student nurse aide programs in critical care

In an effort to deal with the critical nursing shortage, new graduate nurses are entering highly specialized areas that once were available only to experienced nurses. A critical challenge exists for the new graduate when faced with the application of intensive theoretical knowledge in practice, and implementation of high-technology interventions, to meet the needs of patients and families. Innovative strategies are required to prepare the new graduate for this high-acuity practice environment and lessen the impact of reality shock. This article describes the implementation of medical-surgical nurse extern and student nurse aide programs that expanded to critical care. Program outcomes included positive feedback from participants about increased clinical experience, RN role perception, and comfort in the clinical practice setting. Program components are detailed, outcomes discussed, and implications for practice presented.     

Enhancing knowledge and self-confidence of novice nurses: The "Shadow-A-Nurse" ICU program

The nursing shortage in the United States has resulted in a need for newly graduated novice nurses to rapidly transition into the nursing workforce. Although some nursing schools provide clinical experience in the intensive care unit (ICU), many novice nurses are not confident about their skills in providing critical-care nursing. To assist novice nurses in rapidly transitioning into the ICU nurse role, an innovative internship program for novice nurses was designed and implemented. A pilot study was conducted to determine if working with experienced nurses in the ICU environment, in addition to formal education and skills training in critical-care nursing, enables novice nurses to effectively transition into the role of ICU nurse. Qualitative and quantitative results of the program after the second year are discussed.     

肿瘤专科护士临床实习需求的调查分析

目的：调查肿瘤专科护士学员临床实习需求现况,为教学基地临床带教的改进提供依据。方法：自制调查问卷对中华护理学会2011年肿瘤专科护士培训班的96名肿瘤专科护士学员进行调查,并对结果进行统计分析。结果：肿瘤专科护士学员中71.88%希望在专科医院进行实习,在实习安排方面新技术新业务的学习需求最高,其次为示范操作、专科护理诊疗技术;需求较低的为临床护理教学、护理会诊及论文撰写、辅助检查技能。结论：学员对临床护理实践技能方面的需求较高,而对教学与科研能力重要性的认知与临床对肿瘤专科护士的要求有较大差距。     

Understanding experience in nursing

Background. This paper reviews research that considered the life stories of experienced nurses and the relationships between life experience, the way in which people find meaning in their experience(s), the development of nursing knowledge, and the influence of these events and understandings on the characteristics and clinical practice of experienced nurses. Aims and objectives. The dominant perspectives in nursing about the place of experience in the development of nurses’ practice are considered and the paper argues for a broader understanding of experience; placing experience within the context of nurses’ lives, connection with others and their individual understandings about nursing care. Relevance to clinical practice. The place of experience in the development of nurses has not been well understood although the nursing discourse continues to value clinical experience highly. Becoming experienced as a nurse is described as a progressive and continuous interaction between experience, meaning and the lived world resulting in a personal and unique understanding of practice. The culture and discourse of nursing have tended to exclude or dampen individual difference and the paper considers a more expansive understanding of the place of experience and individual difference in nursing and the relevance of this perspective for the education of nurses.     

Articulating nursing in an interprofessional world

It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments.     

Role transition from student nurse to staff nurse: Facilitating the transition period

BackgroundUndergraduate nursing programmes are designed to equip student nurses with the skills and knowledge necessary for their future work as professional nurses. Influences on the role during the transition period from student to staff nurse are unclear.PurposeThis paper explores the experience of role transition for newly-qualified nurses from an Irish perspective.MethodsA Heideggerian Hermeneutic approach was the research method adopted. Ten newly qualified nurses from one of Dublin's Academic Teaching Hospitals were interviewed. Data were analysed using Van Manen's thematic analysis. Influences on the transition period were explored in the context of Chick and Meleis's Transition Concept.FindingsNewly-qualified nurses initially felt excited upon qualification. However, professional responsibility and accountability associated with the new role were overwhelming for participants. They felt frustrated when they didn't receive adequate support during transition.ConclusionNewly-qualified nurses need support while they incorporate their knowledge into clinical practice. Hidden influences should as education levels and scope of practice should be considered before nurse educators begin to develop education programmes for undergraduate nurses.     

Australian clinicians and educators identify gaps in specialist cardiac nursing practice.

Change is endemic in both the health care and higher education sectors in Australia. Consequently professional roles and educational pathways must also evolve and adapt, often catalysed by those in leadership positions. Two national Delphi panels, one of cardiac nurse educators and the other of cardiac nurses, were convened to answer the question 'What knowledge, skills and attitudes are required for an expert nurse practising in the highly technological cardiac care environment?' Respondents indicated on a Likert scale the importance of 107 items to the nurse's role in both the 'real' and 'ideal' worlds of practice. Overall there was very strong agreement between the two panels with results indicating that Australian nurses perform close to their ideal in many areas of practice. For 31 of the items, both panels identified that the reality of practice is quite far from their ideal. Both panels agree that 10 of the behaviours are carried out or valued very little in practice. Reasons why nurses are not carrying out these elements of the role to their satisfaction are discussed and remediation strategies suggested. The findings can inform both curriculum development and clinical practice. In the dynamic health care arena, the nursing profession continues to respond to community and professional needs, seeking to establish sound research-based practice and maintain a high quality of clinical care and nursing management. The development of competencies by the Confederation of Critical Care Nurses (1996) is a good example of professional groups taking the initiative both in defining the practice role and providing tools that assist educational bodies to develop programs appropriate for a practice based discipline. Specialty nursing practice is 'under the microscope' in Australia as the profession seeks the best methods to weight nursing activities, measure nursing outcomes and recruit, retain and justify the use of specialist practitioners.     

Enhancing the undergraduate nursing education experience with clinical elective courses

The nursing faculty, in concert with the University's vision of personalized learning for undergraduate students, sought creative opportunities for nursing students to explore distinctive career specialty paths. The development, implementation, and evaluation of three undergraduate clinical electives developed by a School of Nursing (SON) is described here, in collaboration with three clinical practice partners. These nursing elective courses were designed to meet student requests for additional content in specialty nursing practice areas, enhance new nurse career readiness, and meet practice partner staffing needs for nurses with additional knowledge and skills in specific identified specialties. These nursing specialties included perioperative nursing, neonatal intensive care nursing, and oncology nursing. The SON faculty and each practice partner co-developed unique specialty-nursing elective courses that provide foundational specialty knowledge and skills in each practice arena. Project outcomes include enhanced relationships between the SON and practice partners, high levels of satisfaction of students and employers, and subsequent recruitment and employment of these students as new graduate nurses by our practice partners.     

Clinical coaching: a strategy for enhancing evidence-based nursing practice

PURPOSE: The purpose of this article is to describe how clinical nurse specialists can promote the development of knowledge and skills in nurses as one step toward making evidence-based nursing practice the norm in all patient care settings. BACKGROUND: The need for the use of evidence in nursing practice has been highlighted for several decades. Moving evidence more quickly into practice requires that nursing use many strategies. DESCRIPTION OF STRATEGY: The strategy of clinical coaching is proposed in this article for the development of skills in nurses specifically to promote evidence-based nursing practice. Clinical coaching is a relationship for the purpose of building skills. This strategy is aimed at increasing foundational staff nurse knowledge and skills. CONCLUSION: The achievement and maintenance of evidence-based nursing practice take continuous attention from clinical nurse specialists. Clinical coaching is only one part of a comprehensive approach for establishing and sustaining evidence-based nursing practice.     

Retaining and transferring nursing knowledge through a hospital internship program

In healthcare, organizations recognize that human capital is their most valuable asset. The importance of investing in knowledge workers is imperative given the current and future shortage of health professionals. Knowledge acquisition occurs through continuous learning and the transfer of information from those who are highly experienced to those who are less qualified. At St. Michael's Hospital, two innovative and unique programs were created for the transfer of knowledge. The first was a nurse fellowship program that enabled experienced nurses to spend two to three months learning new skills to advance clinical practice. The second was a nurse internship program in which new graduates spend three to four months in their area of hire to enhance clinical practice through skill development and prioritization of patient care needs. This paper describes both programs and presents an evaluation of the new-graduate internship program as an opportunity for professional development and career enhancement For nurse interns, the program promotes self-esteem and professional confidence, improves job satisfaction and rewards nurses for their contribution. For nurse preceptors, the program provides job enrichment, experience in teaching and recognition by the organization and peers that they are knowledge experts. In healthcare, organizations have come to acknowledge that their most valuable asset is human capital, in particular, knowledge workers (Horibe 1999). Knowledge workers contribute a composite of information, intellectual property and experience (Horibe 1999), acquired by study, investigation, observation or practice (Webster's Dictionary 1989). Investing in knowledge workers is investing in the future. In this regard, organizations have implemented recruitment and retention strategies to attract, retain and advance the highest calibre of health professional. Knowledge workers contribute to an organization through their ideas, analyses of complex situations and sound judgment in decision-making (Horibe 1999). They further develop these skills over the course of their career through continuous learning. This paper will focus on the importance of investing in nurses as knowledge workers. In particular, given the shortage of nurses and the reality that 25% of today's nurses can retire over the next 10 years (CNA 2001), it is imperative that knowledge transfer occur from highly experienced to less experienced nurses.     

What is the Role of the Quality Improvement Radiology Nurse?

This article aims to report the role of the quality improvement radiology nurse. The quality improvement nurse must possess the knowledge, skills, and attitudes to deliver safe and quality care. There is a lack of guidance that describes the role of the quality improvement radiology nurse. The Quality Education for Nurses Framework and Kotter's model both provide a foundation for describing the role of the quality improvement radiology nurse. More research is needed to analyze the role of the quality improvement radiology nurse. Implications to nursing practice, education, and research are discussed.     

The learning experiences of senior student nurses who take on the role of standardised patient: A focus group study

The use of clinical simulation involving standardised patients is increasing in nursing education programmes. In this study, we sought to identify whether participation in simulation through taking on the role of standardised patients benefited student nurses in terms of knowledge and skill development, and if so, how. Data was collected in two focus group interviews with fifteen senior undergraduate nursing students in 2011 and subjected to processes of thematic analysis. Four main themes were identified—seeing the nurse through the eyes of the patient, using observation skills, using reflection and evaluation. Being in the standardised patients role provided students with the opportunity to apply the clinical skills of observation, reflection and evaluation to gain new insights into their own practice, particularly their communication skills. Although there were unique learning opportunities for senior student nurses offered by their experience as standardised patient, more research is need to determine how well this knowledge is translated into practice as they take on the role of registered nurses in the future.     

Clinical teaching by community nurses in the Australian context

A study was conducted to explore factors that impact on the clinical teaching role of community nurses involved in the education of pre-registration nursing students. Respondents were community nurses working in the Western Sydney Area Health Service in New South Wales, Australia. A self-report questionnaire was developed to collect data. Results indicate that community nurses are interested in clinical teaching, that it is an important part of their role and that they perceive themselves to be effective clinical teachers, with the majority indicating motivation to continue developing their clinical teaching skills. Aspects of clinical teaching important to community nurses included facilitating the transition of education from theory to practice, sharing expertise, knowledge and skills and maintaining high standards of nursing practice. There was little support for the view that community nurses experienced difficulty in managing the dual teaching and practice role. Approximately a third of participants reported that being with a student on a one-to-one basis could be stressful. Strategies to assist community nurses in their clinical teaching role were identified.     

Making the move: from bedside to camera-side

The tele-intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity for career and knowledge expansion while reducing some of the physical and emotional risks encountered at the bedside. The role of the tele-ICU is still evolving but focuses on 4 areas of responsibility: performing virtual rounds, managing patient alerts, providing ICU support, and coaching or providing teaching moments. The transition from the bedside into the tele-ICU role can be complex as tele-ICU nurses encounter ICU acceptance barriers and a lack of or a change in professional identity. A formal orientation program focused on competency is necessary for the successful transition from bedside nurse to tele-ICU nurse.     

Coffee,Chaos, and Competence: A Day in the Life of a Radiology Nurse

The role of a radiology nurse is not clearly understood by patients or nursing colleagues. Following a radiology float nurse through a day in a complex radiology practice in a Magnet-designated facility illustrates how a radiology nurse must incorporate specialty education and training, clinical competence, and a professional nursing practice model to provide quality patient care.     

Dissemination of Nursing Knowledge: The Application of the Model of Change

Despite the dramatic growth of nursing research and the development of nursing theory over the last 25 years, concern remains that nurses frequently fail to base their practice on the findings and recommendations of research. It is through research conducted by nurses that new knowledge can be obtained in order to implement good quality care in clinical practice. However, even when new knowledge is gained, its dissemination remains low. Several barriers to the dissemination of nursing knowledge in clinical practice have been identified. These include: lack of awareness of nursing research, lack of knowledge of the research process and the inability to understand research reports. These factors may contribute to negative attitudes among nurses regarding the use of nursing research in their clinical practice. However, research must filter down from academia to practicing nurses at all levels but it cannot make practicing nurses use research. One of the main priorities in the dissemination of nursing knowledge in clinical practice is to make research findings more “user friendly.” The use of a clinical nurse specialist or research nurse (that is a nurse with a defined role within research), combined with an action research approach, could increase the utilization of research findings in clinical nursing. The use of Journal club, research seminars, research workshops and nursing conferences are some of the enabling process in order to increase the dissemination of knowledge. The use of the model of change would enable us to understand whether nurses have the readiness to change and implement new nursing knowledge in to practice.     

Preparing nurses to work effectively in the prison environment

Nurses who go to work in prisons begin their new career without having had any specific preparation for this unique and diverse role. The demands placed upon nurses are unlike any they will have experienced in their previous clinical posts. The work of a nurse in prison contains elements of both mental health nursing and practice nursing. The context in which this nursing occurs means that the nurse is presented with complex clinical and professional dilemmas. Consequently, few nurses start to work within this specialty with all of the core competencies required to be clinically effective and confident in their role. This article describes how this unmet educational need was addressed by the development of a diploma level module.     

Evidence-based nursing in clinical practice: implications for nurse educators

To improve patient outcomes currently and in the future, it is important that an evidence-based approach to nursing care be incorporated into clinical practice settings. Nurse educators and clinical nurse educators have a mandate to model and facilitate evidence-based nursing through learning activities. Unfortunately, issues present within clinical practice settings have made this approach difficult for registered nurses to fully incorporate into practice. This article outlines issues inhibiting evidence-based nursing, such as time factors, access to information and resources, nurses' research knowledge, skills, and learning opportunities, and the current nursing culture. Strategies for change that can be used by clinical nurse educators to enhance the use of evidence-based nursing in clinical practice areas are also described.