Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies

ObjectiveThis systematic review describes the experiences of the orientation into nursing of newly graduated nurses.DesignSystematic review.MethodsData was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC (ProQuest). Qualitative, peer reviewed, original studies published in English, Swedish or Finnish before February 2016 and exploring newly graduated nurses’ experiences of the nursing orientation process were included. The studies were selected by screening titles, abstracts and full texts and the quality of the studies was assessed by two researchers independently. Data was analysed using content analysis.ResultsThirteen studies were chosen for the review. Newly graduated nurses’ orientation experiences were divided into four main categories: experiences related to orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation and suggestions for changes based on orientation experiences. The findings establish that the orientation and the preceptor have a great impact on how newly graduated nurses experience the start of their career. Often, newly graduated nurses wish to continue their relationship with their preceptor after the orientation period.ConclusionsResults bring together both the positive and negative aspects that newly graduated nurses relate as regards their current orientation programmes. Attention needs to be paid to the variation and imbalance in the quality of orientation programmes and preceptors. A more formal form of mentorship needs to be developed further.     

Women's experiences of workplace gender discrimination in nursing: An integrative review

BackgroundThere is an extensive body of literature detailing the career paths of male registered nurses and the benefits they receive in nursing. Whilst there are individual studies which have examined workplace gender discrimination in nursing, there are no reviews which have reported collectively on the findings.AimThe aim of this integrative review was to identify the major forms of workplace gender discrimination experienced by women in nursing and to examine explanations and practices which contribute to gender-based employment discrimination.MethodsAn integrative review of the literature was undertaken, guided by the five strategies for the integrative review method outlined by Whittemore and Knafl (2005). The electronic databases of CINAHL, PubMed, Scopus, SocINDEX, and PsycINFO were searched using a predetermined search strategy.FindingsEleven studies met the quality for inclusion in the review. Major themes identified were: The gender pay gap, Career progression and Human capital.DiscussionA gender pay gap in favour of male nurses remains evident in some countries and faster career progression irrespective of experience and qualifications. Female nurses’ career progression remains stagnant as a result of career interruption. Policy needs to be embedded into clinical practice to support female nurses’ career progression and equality in the workplace.ConclusionsThe narrative needs to be shifted to support female nurses’ intentions to return to the workplace following a period of leave or absence rather than being made to feel excluded and not worthy of progressing their careers. The nursing workforce culture needs to change, however, this change is only possible when we accept that women make valuable contributions to nursing that need to be equally accounted for.     

The White/Black hierarchy institutionalizes White supremacy in nursing and nursing leadership in the United States

BackgroundBlack/African American nurses (BAANs) in the United States (US) experience barriers to career advancement.AimThe specific aims of this study were to a) explore how the perception of racism or racial bias affects the motivation of Black/African American nurses (BAANs) in the United States (US) to seek and apply for nursing leadership and faculty positions, and b) to characterize the racism-related barriers that BAANs perceive that prevent them from moving forward with their careers in academia and nursing leadership.MethodAs part of a qualitative focused ethnographic study, 30 nurses who self-identified as BAAN, had a bachelor's degree or higher, and had at least five years of nursing experience were interviewed. Qualitative data underwent thematic analysis.ResultAlthough five themes were identified, four were established in the literature, and one – Nursing Leadership Dynamics (NLD) – was novel. A complex network of NLDs that served to both prevent the success of BAANs as well as threaten their job security and health was identified.ConclusionThis study identified a multi-faceted, tightly-woven system of NLDs that serves to continually institutionalize and enforce a white/black hierarchy and white supremacy in nursing at all levels in the US, including education.     

从护理论文发表现状认识护理本科生科研能力的培养

目的通过对临床本科护士科研能力、积极性和近年来护理论文撰写和发表现状的回顾,探析导致本科护士科研能力不强的相关因素和培养方法。方法调查1999—2003年毕业于原上海第二医科大学护理系87名本科护士的个人自身发展需求、论文撰写和发表情况;分析2001—2003年刊登于国内3种核心护理期刊的571篇护理论著。结果在68名临床本科护士中,将从事护理科研作为自身发展首位意向的为6人（8．82%）;所撰写的护理论著在护理核心期刊的刊出率为11．33%。在回顾的已刊出论著中,属前瞻性研究为38．18%,实验性研究为23．99%;研究样本数小于或等于100例的为57．44%;有统计学处理和描述的为58．67%。结论应通过多途径提高本科护士的科研能力,包括完善护理科研课程体系的建设、适度培养学生的科研能力、提高护理师资科研素质、加强本科护士职后科研能力的培养。     

Capabilities that experienced nurses expect of new nurses in pediatric wards: A research study using Q methodology

BackgroundTo meet the expected levels of nursing care in pediatric wards, it is necessary to identify and strengthen the skills, job satisfaction levels, and personality characteristics required of nurses.ObjectivesThis study aimed to identify the types of capabilities experienced nurses expect of new nurses in order to perform professional nursing in pediatric wards.DesignQ methodology was used to explore the subjective perceptions of experienced nurses regarding new nurses.SettingThe research was conducted in the pediatric wards of university hospitals.ParticipantsA convenience sample of 31 experienced nurses was recruited for the P-set from the pediatric wards of university hospitals.MethodsData were collected from the 31 participants from August to December 2019.ResultsBased on the study results, the abilities experienced nurses expect new nurses to possess were grouped into three categories: 1) “honesty and effort type,” 2) “problem-solving type,” and 3) “relationship-oriented type.”ConclusionsThis study provides basic data for constructing a program that is advantageous for clinical practice and for the education of pediatric nurses. The results also suggest that increasing the effectiveness of collaboration, understanding, and communication between newly graduated and experienced nurses may improve the level of professional care provided in pediatric wards.     

Nursing workforce,education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: A qualitative substudy

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units.MethodsThis was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service.ResultsFour themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles.ConclusionThis study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.     

Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis

BackgroundThe home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required.ObjectivesThe aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice.DesignAn exploratory qualitative think-aloud design with protocol analysis was used.SettingsHome healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway.ParticipantsA purposeful sample of eight registered nurses with one year of experience.MethodsEach nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis.ResultsRecently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies.ConclusionsOur results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes.     

Healthy eating and physical activity among new graduate nurses: A qualitative study of barriers and enablers during their first year of clinical practice

BackgroundNew graduate nurses entering the workforce experience numerous barriers to maintaining a healthy lifestyle including shift work, the high cost of healthy foods at the workplace and high levels of exhaustion which reduce motivation to participate in regular physical activity. Research has documented unhealthy lifestyles among nurses across the profession. However, few studies focus on graduates' experiences during their transition into their careers.AimTo investigate the barriers and enablers to healthy eating and participation in physical activity for new graduate nurses during their first year of clinical practice, and to explore attitudes to participation in workplace health promotion programs.MethodsSemi-structured interviews informed by the socioecological model were conducted with 24 new graduate nurses and analysed using thematic analysis.FindingsFour key themes emerged as barriers to healthy eating and physical activity: time, shift work, work environment, and work culture. Participants indicated a high interest in workplace health promotion programs.DiscussionLimited time and shift work impact on the eating and physical activity behaviours of new graduate nurses which leads to unhealthy snacking to maintain energy, as does high levels of exhaustion, reduced motivation to eat healthy foods, and decreased participation in physical activity. The work culture and environment also influence eating behaviours. Inadequate breaks lead to consumption of foods that are quick to eat but often low in nutrients.ConclusionNew graduate nurses experience the same difficulties in maintaining healthy lifestyles as more experienced nurses. Understanding the barriers which influence their dietary and physical activity behaviours can help inform strategies to improve the health of nurses at a critical time when they enter the nursing workforce.     

Barriers to nurse-led pain management for adult patients in intensive care units: An integrative review

ObjectiveThis integrative review sought to identify and synthesise quantitative and qualitative evidence on barriers to pain management in adult intensive care units (ICUs).BackgroundPain is experienced by 58% of adult ICU patients, which leads to consequences such as decreased healing and delirium. Managing pain effectively is an integral part of the critical care nurse's role.MethodsAn integrative review was conducted based on Whittemore and Knafl's approach. Peer-reviewed research articles were sourced from five databases. Included articles were limited to those published in English and Arabic. The quality of included papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). Identified barriers to pain management in adult ICUs were mapped onto the components of the COM-B model. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsNine hundred and ninety-one papers were identified; 19 studies met the inclusion criteria. Seventeen studies focused on pain management from the perspective of nurses, whereas the remaining two focused on the perspectives of patients and nurses. Using the MMAT, two studies were rated 5 stars (out of 5), nine studies were rated 4 stars, seven studies were rated 3 stars, and one study was rated 2 stars. Lack of knowledge and skills was found to be psychological capability barriers, while nurse dependency on following doctor's orders, poor staffing levels, lack of pain assessment skills, and lack of education were barriers mapped to physical capability. Opportunity was represented by three barriers: inadequate documentation of pain and shortage of nurses were mapped to the physical opportunity, and poor communication to the social opportunity. Nurses' beliefs towards pain assessment were mapped to reflective motivation.ConclusionsThe findings of this study suggest that knowledge, nursing beliefs, insufficient numbers of nursing staff, lack of documentation, and lack of communication commonly affect pain management in adult ICUs.Prospero registrationCRD42020179913     

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.     

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 value of simulation-based education in developing preparedness for acute care situations: An interview study of new graduate nurses’ perspectives

AimThis study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion.BackgroundSimulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses’ ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice.Design/methodDuring the winter of 2021–2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis.ResultsThe results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding.ConclusionSimulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.     

“If somebody just showed me once how to do it”: How are workplace cultures and practice development conceptualised and operationalised for early career nurses?

BackgroundAn imminent nursing shortage mandates attention to retention of early career nurses. One factor that impacts on intention to stay in the profession is the ability to do the work. Early career nurses rely on supportive cultures to develop the practical skills and knowledge specific to particular workplaces.ObjectivesThis study was conducted to determine the impact of workplace culture on practice development for early career nurses.MethodsWe undertook a qualitative study using semi-structured interviews conducted with eleven early career nurses at a single metropolitan hospital in Melbourne, Australia. Interviews were transcribed verbatim and analysed using thematic analysis techniques.ResultsThemes identified were learning in the moment, active welcome, confidence, ambiguities in the culture of learning, bullying and navigating the space.ConclusionsEarly career nurses conceive practice development as the acquisition of skills and knowledge particular to the immediate needs of their patients, which they learnt by asking questions. Developing confidence was integral to all aspects of practice development. Complexity and risk on the wards could negatively impact on confidence. Where welcome was explicit and overt the nurses felt that practice development was facilitated. Transition to practice programs supported nurses and some individual nurses were active in assisting nurses to develop. However, workplace cultures were at times indifferent to the learning needs of the early career nurses and some experienced poor workplace behaviour and bullying.     

Job and career satisfaction and turnover intentions of newly graduated nurses

laschinger h.k. s. (2012) Journal of Nursing Management  20, 472–484 Job and career satisfaction and turnover intentions of newly graduated nurses Aim To describe new graduate nurses’ worklife experiences in Ontario hospital settings in the first 2 years of practice and to examine predictors of job and career satisfaction and turnover intentions. Background With a large cohort of nurses approaching retirement, every effort must be made to ensure that the work environments of new graduate nurses are positive, promoting job satisfaction and commitment to the profession to address the nursing workforce shortage. Method A cross-sectional analysis of data from a mail survey of new graduate nurses (n = 342) in their first and second year of experience was used to address the research objectives. Results Overall, new graduate nurses were positive about their working conditions and there were few differences between nurses in their first and second years of practice. Structural and personal factors explained significant amounts of variance (31–68%) in both job and career satisfaction and turnover intentions. Empowerment, work engagement and burnout were important significant predictors. Conclusions Modifiable workplace factors play an important role in influencing new graduates’ job and career satisfaction and turnover intentions. Implications for nursing management Managers can employ strategies to enhance quality work environments that promote retention of new graduates and lessen the nursing workforce shortage.     

Qualitatively exploring the attributes of adaptability and resilience amongst recently graduated nurses

AimTo explore newly graduated nurse’s understandings and practices of adaptability and resilience in clinical environments.BackgroundThe everyday practice of nursing work involves managing emotional and practical everyday demands related to the role. Adaptability and resilience are two critical attributes that equip nurses for this by enabling them to manage challenges and be flexible with their practices and expectations in the face of rapidly changing and unpredictable circumstances.DesignInformed by the theoretical underpinnings of the Person-centred Practice Framework, semi-structured interviews using topic guides were conducted with nine newly graduated registered nurse participants recruited through purposive sampling. Interviews occurred between March-October 2020 with participants working across seven different healthcare settings in three Local Health Districts in NSW, Australia.ResultsAnalysis of the data generated the core themes of: 1) ‘Making sense’ explored how nurses defined resilience and adaptability; 2) ‘Surviving as the nurse’ focused on how nurses experienced adaptability and resilience as a newly qualified nurse; 3) ‘Trusting oneself’ reflected the interconnection of nurses’ developed adaptability and resilience to their clinical self-assurance; and 4) ‘Doing it again’ described how adaptability and resilience can be further supported by the university sector. Findings demonstrated that adaptability and resilience in combination are essential attributes and required for effective nursing practice post-graduation. However, both collegial and organizational support were found to be lacking in positively reinforcing these attributes in this study.ConclusionNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.Tweetable abstractNewly graduated nurses can develop adaptability in clinical practice, so they are a more resilient future workforce. However, greater organizational leadership is required to model and strengthen these attributes for nurses. When perceptions, knowledge and experiences of adaptability and resilience are developed using person-centred approaches, they will be used in person-centred ways.