Preparing nurses for practice: a phenomenological study of the new graduate in Australia

Aims. To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. Background. Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. Design. Husserl’s phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. Methods. Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi‐structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. Results. As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for ‘bitchiness’ and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. Conclusions. Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. Relevance to clinical practice. Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment.     

Relationships between role models and role perceptions of new graduate nurses

This study was conducted to examine relationships between role models and role perceptions of new graduate nurses. The sample consisted of the 25 senior nursing students in a generic baccalaureate nursing program who were administered questionnaires 1 month prior to graduation and 3 months after beginning employment. Results indicated that: (a) a majority of faculty role models of new graduate nurses are replaced by work-related role models in the first 3 months of employment, (b) the most important role model characteristic was clinical experience/performance, and (c) role perception orientations of new graduate nurses are overwhelmingly professional prior to graduation, but become more bureaucratic after exposure to work-related models. This study validates the findings of similar research conducted over the past 25 years. Further research is needed into factors that lead to the perpetuation of a bureaucratic work environment and bureaucratic nurses, in spite of professionally oriented nursing education.     

Being different: A phenomenological exploration of a group of veteran psychiatric nurses

Concern regarding the low numbers of graduate nurses expressing interest in entering the psychiatric field leads to the question: who would be a psychiatric nurse? In this interpretative, phenomenological study, the lived experiences of seven veteran psychiatric nurses were examined in order to gain understanding of the reasons why they had remained in the field of psychiatric nursing. Each of these participants had more than 10 years' clinical practice in psychiatric nursing and shared a wide range of thoughts, memories, and experiences. The major emergent theme, ‘being different’, revealed what it is like for the participants being psychiatric nurses. These participants felt and saw themselves as different in many ways from other nurses and from society in general. Related to and an aspect of that difference was the high level of satisfaction they achieved from their role and the striving to achieve harmony.     

Exploring the experiences of beginning registered nurses entering the acute care setting

This study begins to explore some of the social and political issues surrounding the practices of the graduate nurse. Utilising an ethnographic methodology with a critical intent, 4 graduate nurses describe their experiences of clinical practice. The major themes raised or issues that were embedded within the nurses' stories revolved around power and control enmeshed within nursing practice. The themes discussed relate to the graduates' perception of their own competence, and the concepts of the ideal nurse, the socialisation of graduates into the ward culture, being on insider or outsider and a good or bad nurse. The resulting discussion utilises the theoretical framework of Foucault's governmentality to suggest ways in which nurses and graduates might make sense of these issues.     

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.     

Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross-sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients’ experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse-patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse-patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care.     

The role of mentoring in developing African American nurse leaders

The primary purpose of this study was to explore the role of mentoring in the development of African American nurses who have achieved leadership positions in baccalaureate and graduate nursing programs. This study also explored similar and dissimilar mentoring experiences in same-race versus cross-race mentoring relationships. The theoretical framework for this study was Levinson's adult developmental theory. A sequential mixed design was utilized. Forty-seven African American nurse leaders participated in Phase 1, and 10 of the 47 were interviewed in Phase 2. The findings showed that mentoring plays a role in the personal and professional development of African American nurse leaders in baccalaureate and graduate nursing programs. Moreover, the relevance of race varies in both same-race and cross-race mentoring relationships.     

Job satisfaction among Iranian hospital-based practicing nurses: examining the influence of self-expectation, social interaction and organisational situations

ravari a ., bazargan m ., vanaki z . & mirzaei t . (2012) Journal of Nursing Management  20, 522–533 Job satisfaction among Iranian hospital-based practicing nurses: examining the influence of self-expectation, social interaction, and organisational situations Aim The influence of self-expectation, social interaction, and organisational situation on job satisfaction among nurses is examined. Background Understanding determinants and correlates of job satisfaction are important factors that help to reduce the problem of nurse attrition. Methods Utilizing the Hybrid Model of concept development, job satisfaction was examined in three phases: (1) the theoretical phase, a working definition and the dimensions of job satisfaction were established; (2) the fieldwork phase, a qualitative semi-structured interview was employed to capture participants’ perceptions of the concept; and (3) the analytical phase, the experiences of nurses were evaluated using the conceptual model. Results The results indicate that personal beliefs, rather than social interaction or organisational situation, constitute the core of job satisfaction. Conclusions Despite the variety of dissatisfaction factors rooted in social interaction and organisational situation, participants achieved the highest job satisfaction when trusting in self-value systems and the spiritual value of their job objectives. Implications Intervention is needed to increase organisational and professional support for nurses. However, highlighting the sacred and spiritual value of the nursing profession, which is rooted in religious values and culture, provides additional reinforcement for enhancing the job satisfaction among this segment of health care providers.     

Mistrust of academic knowledge among nurses in Slovenia

DOMAJNKO B. & PAHOR M. Mistrust of academic knowledge among nurses in Slovenia. International Nursing Review 57 , 305–311 Aim: The paper discusses the negative attitudes of some nursing assistants in Slovenia towards higher nursing education and academic (theoretical and research based) knowledge. Background: The topic is discussed in the context of traditional hierarchical and patriarchal relations in the health‐care sector, professionalization of nursing and the evidence‐based debate in nursing. Methods: A secondary analysis of data gathered in 2005 was carried out. The topic of the original research was the interprofessional collaboration between medical and nursing care professionals in Slovenia. The secondary study looked closely into the relations within nursing care. Specifically it focused on the nursing assistants' perspective. Five hundred ninety‐two answer to two open‐end questions (307 from nurses and 285 from nursing assistants) and five semi‐structured interviews (with three nurses and two nursing assistants) were re‐analyzed (with the new focus), applying inductive qualitative content analysis and the pragmatic approach to interpretation. Findings: In nursing assistants' view, the difference between themselves and graduate nurses was described in terms of the distinction ‘work – non‐work’. Higher education was associated primarily with striving for higher social status. Academic knowledge was not perceived to include the right competencies for either practising or improving the quality of nursing care. Conclusions: The mistrust of the academic nurse on the part of some nursing assistants is interpreted as a barrier to full professionalization of nursing care and also interprofessional collaboration in the health‐care sector.     

The developing role of transition to practice programs for newly graduated mental health nurses

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.     

Preserving moral integrity: a follow-up study with new graduate nurses

Preserving moral integrity: a follow-up study with new graduate nurses ¶The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the ‘real world’ of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the ‘real world’ of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one’s moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.     

The professional self-concept of new graduate nurses

The purposes of this study were to: (1) describe the level of professional self-concept among new graduate nurses working in critical care and general medical surgical unit six months after completing a nursing program, (2) examine the professional self-concept in relation to age, marital status, and educational level of new graduate nurses, and (3) examine graduate nurses' perceptions of their nursing educational preparation for their clinical area. One hundred thirty two (n=132) new graduate nurses completed the professional self-concept nurses instrument (PSCNI) and answered two open ended questions focused on their educational preparation. Scores on the PSCNI ranged 58-106 with an overall mean of 83. There was a positive correlation between age and level of professional self-concept. Single factor ANOVA showed no statistical differences between levels of professional self-concept, marital status (p=0.43), and educational level (p=0.09). New graduate nurses identified themes as they assessed their educational preparation for their work experiences.     

Reducing emotional distress in nurses using cognitive behavioral therapy: A preliminary program evaluation

Introduction: Workplace stress among nurses has been associated with high absenteeism, low work satisfaction, and poor retention rates. Aim: This pilot study evaluated the effectiveness of a 1 day stress management program on nurses' stress levels. Methods: The nurse participants attended an 8 h face‐to‐face interactive workshop based on cognitive behavioral therapy. The subjects also were given a self‐directed manual with reading and exercises to use after the workshop. The nurses were assessed at baseline and at 6 weeks postworkshop attendance using the Nurse Stress Scale (NSS). They were asked to rate their level of stress at work, outside of work, and their overall stress. The participants also were asked to evaluate the perceived usefulness of the workshop at follow‐up. Results: The sample consisted of 18 new graduate nurses halfway through their first year. The NSS subscales “nurse–doctor conflict”, “death and dying”, and “nurse–nurse conflict” showed statistically significant improvement at follow‐up. The ratings of stress at work, outside of work, and the overall stress also showed statistically significant improvement. Conclusions: The workshop was well‐received by the new graduate nurses. The pre/post findings suggest a beneficial effect of the intervention. The authors are encouraged by the results and now plan to conduct a multisite, randomized controlled trial to seek to establish a wider evidence base for the intervention.