No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Effective orientation programs for new graduate nurses: A systematic review
Abstract
Objective:
To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.
Method:
A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008-2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program.
Results:
A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization.
Conclusion:
Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.
... In this study report, it is described that retention rates for new graduates in the residency program increased significantly, with residents showing an increase in organization, communication, and clinical leadership (5). Considering the benefits of the nursing residency program approach described in the global literature (5,8,9), it is high time for Higher educational institutions in Ethiopia to consider a transition from classroom lectures to a hospitalbased learning approach to produce graduates capable of offering the best nursing care for the public in Ethiopia (6). ...
... In this study report, it is described that retention rates for new graduates in the residency program increased significantly, with residents showing an increase in organization, communication, and clinical leadership (5). Considering the benefits of the nursing residency program approach described in the global literature (5,8,9), it is high time for Higher educational institutions in Ethiopia to consider a transition from classroom lectures to a hospitalbased learning approach to produce graduates capable of offering the best nursing care for the public in Ethiopia (6). The program follows a hands-on learning strategy where the students also take responsibility for patients' care independently to some level which helps nurses to become fully competent with the transition from a student nurse to independent practicing nurse and a bedside leader (9,10 ...
... Considering the benefits of the nursing residency program approach described in the global literature (5,8,9), it is high time for Higher educational institutions in Ethiopia to consider a transition from classroom lectures to a hospitalbased learning approach to produce graduates capable of offering the best nursing care for the public in Ethiopia (6). The program follows a hands-on learning strategy where the students also take responsibility for patients' care independently to some level which helps nurses to become fully competent with the transition from a student nurse to independent practicing nurse and a bedside leader (9,10 ...
Princess Tsehai became Ethiopia's first national nurse in 1939 (1). Certain sources indicate that the first Ethiopian nurses were trained abroad in 1944. Nursing training in Ethiopia began in 1949 in Addis Ababa by the Red Cross Society at the then Haile-Selassie I Hospital (now Yekatit 12 Hospital), which produced the first graduates in 1953(1). The Haile Selassie I Public Health College was established in 1954 in Gondar, where community nurses' training began in Ethiopia (2). Nursing education in Ethiopia has been at the lower level (diploma) since 1949 and at the post-basic level since 1994. Diploma graduates were expected to perform more varied and complex nursing tasks at any level and in settings that require strong educational backgrounds and competency (2). Nurses play an indispensable role in improving health care standards. However, limited exposure in clinical practice settings hinders nurse professional development. In line with this, studies reported that newly graduated nurses are not well prepared to handle complex clinical patient situations (3) which capitalized the need for educational institutions to develop curricula with pedagogic approaches that promote students' actual learning of clinical skills, clinical reasoning skills, and the ability to apply knowledge to solve patient problems in practice (3, 4). To fill these gaps, a student-active and problem-based pedagogic approach that develops the student's clinical reasoning skills and enhances their readiness for solving patient problems in clinical settings. Globally, nursing education trends have been towards greater professionalization through increasing training periods and shifting from class room based lecture to hospital-based evidence based learning by doing (3). The existing Nursing teaching practices in many higher education institutions in Ethiopia do not take into account the needs of the important strategies of learning. As opposed to this, the world is moving from pedagogy to an andragogy teaching strategy. In this approach, the nursing residency program has been enhancing the 21st-century adult learning strategies, such as student-centered coaching, visual, auditory, and kinesthetic learning, and the teacher as a facilitator model of instruction (5, 6). A nursing residency program is a program that combines classroom instruction specific to the nursing specialty with clinical experience under the supervision and guidance of preceptors, coaches, and the program director (3). It is reported that the Nurse Residency Program (NRP) contributes to producing highly trained nurses with a substantial focus on patient safety by providing the opportunity for nursing residents to gain "real world" experience in the care setting and also supports the nurses in their development as confident and competent practitioners (7). Furthermore, the positive effect of the nursing education approach that involves precepting and practical orientation programs in assisting the recruitment and retention of new graduate nurses in perioperative settings has been described (4). Assessment of ten years outcomes of a post-baccalaureate new graduate nurse residency program also documented objective evidence about the benefits of Nurse residency programs (NRPs) to Hospitals and patient cares (5). In this study report, it is described that retention rates for new graduates in the residency program increased significantly, with residents showing an increase in organization, communication, and clinical leadership (5). Considering the benefits of the nursing residency program approach described in the global literature (5, 8, 9), it is high time for Higher educational institutions in Ethiopia to consider a transition from classroom lectures to a hospital-based learning approach to produce graduates capable of offering the best nursing care for the public in Ethiopia (6). St. Paul's Hospital Millennium Medical College, School of Nursing has taken the first step to move from the traditional classroom-based lecture to a hospital-based residency approach in postgraduate nursing training.
... Onboarding new nurses provides an organization the opportunity to make a strong positive first impression and has a major influence on levels of both engagement and retention beyond their first year (Eckerson, 2018;Goldschmidt et al., 2011). However, many onboarding programs for nurses lack evidence-based research support to measure the vital components such as critical thinking and clinical judgment that are necessary as part of an effective onboarding program for the new graduate nurses (Pertiwi & Hariyati, 2019). The current study compared knowledge and critical thinking before and after implementation of personalized learning during the onboarding of new graduate nurse cohorts. ...
... Low nurse satisfaction is a strong contributor to high turnover rates and turnover intention (Bratt & Felzer, 2012;De Simone et al., 2018). Although an effective orientation program can address certain aspects of reality shock, it can also promote increased job satisfaction for new nurses and lower turnover as well as result in higher competency levels and produce lower stress levels (Pertiwi & Hariyati, 2019). ...
... Higher acuity and more complex care requires a higher level of critical thinking, knowledge, and clinical reasoning regarding disease process and evidence-based practice. Many onboarding programs lack evidence-based research and data to identify where opportunities for improvement exist or even the effectiveness of their process (Pertiwi & Hariyati, 2019). To optimize the effectiveness of onboarding new nurses into an organization, nurse educators should utilize onboarding programs that have the ability to measure the effectiveness and efficiency of their program. ...
Effective onboarding is key to new nurse success; however, many programs lack evidence-based support. The current study compared knowledge, critical thinking, and nurse satisfaction between cohorts before and after implementation of personalized learning for onboarding. Results showed better knowledge, critical thinking, and nurse satisfaction in the personalized learning cohort compared to prior cohorts. Nurse educators should use evidence-based personalized learning for onboarding to fully support new nurses as they transition from the classroom to practice.
... This leads to high employee turnover rates, increased patient safety incidents, and decreased work performance. TPPs that are multidimensional by using didactic, simulation, and clinical preceptors (Pertiwi & Hariyati, 2019) can monitor and sustain a positive culture through education, reporting blatant toxic behaviors and mentoring clinical preceptors as positive role models (Webb & Kohi, 2019). ...
... The selection process for preceptors is imperative for the development of newly licensed RNs. Preceptees will benefit immensely from experienced preceptors who exhibit positive attitudes because this is a key human factor for promoting a conducive culture for clinical teaching (Pertiwi & Hariyati, 2019). There is a need for further studies about best preceptorship and mentorship development training program practices that foster constructive interpersonal relationships. ...
... Because nurses are the largest stakeholder in health care, it is imperative that NPD leaders be mentors, authentic leaders, and empowered to engage with organizational decisions (Institute of Medicine, 2011;Kiss & Smith, 2018). The main aspect of NPD leaders is to utilize multiple orientation strategies (Karnish et al., 2019;Oblea et al., 2019;Pertiwi & Hariyati, 2019;Walsh, 2018). This strategy combines didactic clinical preceptorship, socialization, and simulation/skills laboratories into comprehensive professional development programs. ...
Registered nurses (RNs) are national assets who provide quality patient care, especially during the corona virus disease 2019 pandemic. Currently, healthcare organizations are overwhelmed with ill patients who require RNs with specialty experiences. Curtailment and cancellation by healthcare organizations of civilian and military transition-to-practice programs for newly licensed RNs are at risk. If this phenomenon continues, current and future nursing shortages will prevail.
... These positive outcomes included professional growth, competency, nurse retention (Eckerson, 2018;Read and Laschinger, 2017;Billett, 2016), the overall quality of nurses and service, and positive health outcomes (Speight et al., 2019). However, with the increasing expectation for higher quality care and the complexity of nursing, nursing administrators need to design measurable learning objectives and content to conduct work-integrated learning for newly graduated nurses to improve their clinical competence (Pertiwi and Hariyati, 2019). The education programs for newly graduated nurses differ in terms of the duration, learning objectives, and educational content between health services and countries (Speight et al., 2019;Ding et al., 2020;Zheng et al., 2023). ...
... Scholars emphasized that standardized educational programs for newly graduated nurses must be based on a set of defined core competencies (Cui, 2020;Pertiwi and Hariyati, 2019). However, the focus and emphasis of core competencies somehow vary (Kukkonen et al., 2020;Boyer et al., 2019). ...
Background:
Transition education is a robust strategy to improve the core competency of newly graduated nurses and the quality of clinical nursing and ensure people's safety. Limited information about the learning objectives and educational content for newly graduated nurses in China was available.
Objective:
Construct the learning objectives and educational content for newly graduated nurses based on defined core competencies.
Design:
We used a literature review and the e-Delphi method to conduct this study.
Settings:
Ten tertiary teaching hospitals and six nursing schools in Zhejiang Province, China, were selected.
Participants:
Experts (n = 21) were invited to the e-Delphi study.
Methods:
Based on seven competencies from the literature review and the research group discussions, we formed an initial set of objectives and specific educational content for newly graduated nurses. Subsequently, experts provided supportive and modification advice on the competencies, objectives, and specific content in the two Delphi rounds. The consensus percentage and the weight of each first-level, second-level, and third-level item were calculated.
Results:
Consensus was achieved on seven core competencies, 44 learning objectives, and 60 components of educational content. The positive coefficient of the two Delphi rounds was 100 %, the authority coefficient was 0.83 and 0.87, the proportion of experts who made suggestions was 71.40 %, the coefficient of variation (CV) was <0.25 (P < 0.05) except for two items and the Kendall coefficient (W) was 0.15-0.48 (P < 0.01).
Conclusion:
The developed objectives and content framework provide a reference for implementing systematic and standardized education for newly graduated nurses.
... A robust orientation program delivered through classroom instruction and clinical simulations in a secure and productive learning environment enhances the participants' clinical decisionmaking skills and competence. [1] The advent of the COVID-19 pandemic posed many challenges with the delivery of education; its global spread resulted in the suspension of classes for over 850 million students worldwide, disrupting teaching plans already in place. [2] From March 2020, following the restrictions imposed by the Centers for Disease Control and Prevention (CDC) and Qatar's Ministry of Public Health (MoPH), face-to-face educational activities were cancelled. ...
... This abridged version of the GNO program enhanced the learning experience of new nurses during the pandemic by employing methods that encourage critical thinking and problem-solving. [10,14,15,26] As discussed a robust orientation program must provide learning materials that help bridge the gap from theory to practice [1] which was covered by the asynchronous web-based training, adequate support by educators to new nurses during the simulation training which provided the new comers an safe outlet to voice out their concerns, and established, efficacious teaching methods like online and simulation based education. The learner-centered, flipped classroom approach to nursing orientation has overall positively impacted the nurses' satisfaction with the teaching strategies and learning outcomes. ...
This quantitative, correlational study aimed to determine the nurses' level of satisfaction on the flexible learning modality in the nursing orientation program at Hamad Medical Corporation (HMC) in Qatar during the COVID-19 pandemic. The participants were enrolled in the study using a total enumeration sampling technique which consists of all new nurses hired permanently by HMC from June 2020 until January 2021. The online questionnaire was distributed along with the informed consent/ research information tool and was completed by 212 out of 227 target participants. The survey was divided into these sections: the demographic profile, nurses' level of satisfaction with the flexible learning modality, and their level of technical capability for flexible learning. Statistical treatment using frequencies, means, standard deviation, and Spearman's rank correlation test was used to arrive at the research findings statistically. The study results revealed that nurses who joined HMC during the pandemic were highly satisfied with the nursing orientation program and highly capable of flexible learning. There is also a strong, positive relationship between the participants' level of satisfaction and technical capability. Hence, an enhancement to nursing orientation programs can be developed based on the findings of the study.
... Nurses who are better aligned to their job role can adapt and acclimate to their new environment more quickly, thereby reducing the amount of time spent in onboarding. Orientation for newly licensed RNs can be as short as 6 days or as long as a year (Pertiwi & Hariyati, 2019). Research does suggest that newly licensed RN orientation should be at least 4 weeks long, but these shorter orientations can be just as effective as longer programs (Pertiwi & Hariyati, 2019). ...
... Orientation for newly licensed RNs can be as short as 6 days or as long as a year (Pertiwi & Hariyati, 2019). Research does suggest that newly licensed RN orientation should be at least 4 weeks long, but these shorter orientations can be just as effective as longer programs (Pertiwi & Hariyati, 2019). Decreasing orientation length is a common goal of many onboarding and nurse residency programs (Allen, 2011;Beyea et al., 2010). ...
Preparing new nursing graduates for independent practice as soon as safely possible is vital for both efficient and effective patient care. The alignment between a nurse's personality and specialty practice area may impact orientation length, as nurses who are better suited to their job role may adapt more quickly. The current study revealed that nurses hired into a specialty practice area with a higher job fit demonstrates a significant reduction in orientation time.
... Graduate transition initiatives are increasingly being developed and delivered by health services in urgent need of staff with relevant clinical skills and work aligned capabilities, such as teamwork and effective communication (Pertiwi & Hariyati, 2019). Pre-registration preparation must offer sufficient learning in similar areas to enable scaffolding for this latter advanced education to be successful. ...
Objectives: The review explores current evidence on Australian pre-registration nurse education in preparing graduates to work in mental health settings, from the perspectives of the graduates. Design: A scoping review using the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was undertaken. Results: There were 31 eligible publications, reporting 12 qualitative studies, eight surveys and 11 quasi-experimental studies. All were in English language peer reviewed journals, published between 2000 and July 2023. Five themes emerged: 1. Well-organised and supported clinical placements can reduce stigma; 2. Student concerns regarding mental health clinical placements can be lessened when placements are well-designed; 3. Well-organised and resourced clinical placements can increase interest in mental health nursing; 4. Simulation learning can increase confidence during clinical placements; 5. Teaching by Experts By Experience (EBE) can reduce stigma and improved student attitudes. Conclusion: Evidence from 31 eligible publications indicated that properly resourced, purpose-designed theoretical and clinical learning experiences can be effective in reducing stigmatising attitudes and behaviours in pre-registration nursing students. Involving EBEs in mental health teaching is an important, but so far under-utilised, development in pre-registration nursing programmes in Australia.
... Among the stressors that have already been discussed in the literature include waiting for the results of the National Council Licensure Examination (NCLX), moving out and living independently, and adjusting to the changing demands of work. According to (Pertiwi, & Hariyati, 2019), all of these new tasks frequently cause tension and worry. ...
... Orientation programs often include various activities such as bedside learning, classroom-based sessions, simulations, clinical practice days, as well as preceptorship and mentorship opportunities that are specifically adapted to meet individual needs (Pertiwi & Hariyati, 2019). However, it is appropriate individualized consideration is not perceived as higher as new graduate nurses report interruptions in their orientation period during COVID-19 to mitigate staffing issues or as the consequence of reallocated funding (McMillan et al., 2023). ...
... Topic Findings 1 Orientation program components et al., 2023). By providing a solid foundation of knowledge and support in dealing with practical challenges, orientation programs help new nurses adapt more quickly and effectively to their roles (Pertiwi and Hariyati, 2019). However, it is essential to note that during the orientation process, support for the personality and values of nurses, especially their confidence and proactive values, is crucial (Baharum et al., 2023). ...
Background
Orientation programs for new nurses play an essential role in preparing them for challenges in clinical practice. Different countries have applied varying program components and durations in organizing these programs.
Objectives
To explore the program components, impact, and duration of the orientation programs for new graduate nurses in hospital care settings.
Method
We gathered information from studies conducted in various countries. Searches were conducted on databases including PubMed, Sage Journal, ScienceDirect, EBSCO, and Wiley, with secondary searches from 2018 to 2023 using Arkey and O'Malley's Review Scoping Framework. The inclusion criteria comprised studies with primary data, both qualitative and quantitative, focusing on new nurses undergoing orientation programs in hospitals.
Results
Of the 989 articles screened, 14 were included. Methods identified included providing hands-on experience, sharing information, reflecting on work experiences, and developing technical skills. Significant findings encompassed increased competence, knowledge, confidence, and satisfaction, as well as professional development and positive organizational impacts. The duration of orientation programs ranged from 2 weeks to 2 years, depending on the program type and new graduate nurse needs.
Conclusion
This scoping review elucidates program components, impact, and duration of new nurse orientation programs in hospitals, providing valuable insights for hospital management in designing and developing improved programs.
Tweetable abstract
Exploring program components, impact, and duration of hopitals new graduate nurse orientation programs, revealing insights to enhance patient care and nursing practice@Ns_Ernawaty
... 11 Pediatric cardiac nursing orientation best practices include a variety of learning modalities with specific learning objectives and competencies, including a didactic curriculum, guided clinical experiences with a preceptor, and often simulation. 12,13 Nurse residency programs utilize didactic instruction, precepted clinical experiences, role play, case studies, and simulation to facilitate the transition to clinical practice. 14 In addition to unit-specific clinical content, the nurse residency program includes practice in delegation and prioritization, communication, conflict resolution, critical thinking, leadership, and socialization to the role. ...
Pediatric cardiac programs achieve excellent patient outcomes through the teamwork of a highly capable interdisciplinary team. Nurses are key members of this team, and must possess and highly specialized set of skills and knowledge. A comprehensive nursing education program is needed to develop the necessary skills and knowledge to care for critically ill infants and children with heart disease who are often highly unstable, complex, and vulnerable. Orientation of novice nurses or those who are new to the unit begins with a needs assessment, resulting in a comprehensive plan to achieve required competencies. Nurse residency programs are one method to provide a comprehensive orientation to novice nurses, using a combination of didactic instruction, preceptored clinical experiences, and simulation. An ongoing nursing education plan is also important to refresh skills, especially with high-risk, low-volume procedures, as well as to meet regulatory requirements and develop new skills and knowledge. A key component of the pediatric cardiac nursing education plan is development of preceptors, who provide hands-on instruction to mentor new nurses to develop the needed skills and knowledge, while ensuring that patients receive safe care. Preceptor development can also provide experienced bedside nurses with opportunities to develop their own knowledge and to continue professional development, which helps to positively influence job satisfaction. Numerous resources are available to develop a curriculum or the pediatric cardiac program. Evaluation is also an important component of the nursing education program, to quantify individual as well as programmatic outcomes.
... A study by Zhai et al. (2023) similarly found that a lack of support and opportunities for learning and growth can lead to disillusionment and dissatisfaction among new graduate nurses. Likewise, a study by Pertiwi & Hariyati (2019) suggested that inadequate onboarding programs can lead to decreased job satisfaction and increased turnover rates. ...
Background
The commitment of nurses to their profession and workplace is closely linked to the delivery of high‐quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace.
Aim
To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment.
Design
A focused ethnographic study.
Methods
Data consisted of field notes from 94 h of participant observations and 10 semi‐structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022.
Results
The findings reveal a major theme, termed ‘A State of Transience among Newly Graduated Nurses’, consisting of two themes: ‘Newly Graduated Nurses’ Pursuit of Professional Development and Supportive Work Environments' and ‘A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.’
Conclusion
Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high‐quality patient care, thereby reducing the likelihood of turnover.
Relevance for Clinical Practice
A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit‐level models and measures.
Reporting Method
This study reports to the SRQR guidelines.
Patient or Public Contribution
No patient or public contribution.
... In recent years, there has been a growing interest in exploring the effectiveness of strategies to improve the retention of NGRNs (Asber, 2019;Pertiwi & Hariyati, 2019;Van Camp & Chappy, 2017) and their characteristics (Brook et al., 2019). However, there is a gap in the literature on identifying and describing effective interventions for the retention of NGRNs in hospital settings. ...
Background:
There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital settings. To the best of our knowledge, no systematic review has been conducted on this issue.
Aim:
To identify effective interventions that promote the retention of newly graduated registered nurses in the hospital setting and their components.
Design:
A systematic review was conducted according to PRISMA 2020 Statement.
Methods:
Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012-October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi-experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion.
Results:
Following the critical appraisal, nine studies were included. The evidence reveals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross-cutting and specific), their components (programme development framework, duration, content and support components), and shows significant improvements after their implementation.
Conclusions:
This systematic review identifies that either nurse residency or individualised mentoring programmes, lasting 1 year, and multi-component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting.
Relevance to clinical practice:
The knowledge provided by this review will contribute to developing and implementing more effective and context-specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs.
No patient or public contribution:
Given the study design and focus.
... This finding is in congruence with Mohamed, Elmolla and Abdeen workshops, and seminars for nursing staff to refresh their knowledge, related to safety measures. In the same regard, Pertiwi and Hariyati (2019) found that orientation programs have a positive effect on nurse competence. ...
... Efficacious orientation programs have wellestablished goals using proven learning materials with support systems such as preceptorship, simulation, mentorship, and appropriate learning methodologies. These tenets connect education to real situations and validated evaluation tools to measure retention, turnover, and job satisfaction (Pertiwi & Hariyati, 2019). ...
Nursing professional development and human resource leaders revised general nursing orientation content and structure based on changes because of COVID-19 in length, focus, and platforms from the early stages of the pandemic. The aim of this quality improvement project was to incorporate best of pandemic modifications with key stakeholders and new-to-practice and experienced nursing hire needs emerging from COVID-19 realities on the workforce. The benefit for nursing professional development practitioners is relatability of general nursing orientation revisions for sustainability of clinical excellence and safety.
... Also, novice nurses also took part in self-learning to answer questions they had themselves and to learn the principles of caring for patients with COVID-19 by using various methods such as searching Google and watching YouTube video clips (Fernandez et al., 2020). The learning or training methods of these novice nurses or healthcare providers met the new staff orientation requirements that were covered when they started their practical work or profession (Marks et al., 2020;Pertiwi & Hariyati, 2019). ...
Aims:
To explore the experiences of novice nurses caring for patients diagnosed with COVID-19 in Thailand.
Design:
A qualitative descriptive research.
Methods:
The experiences of twelve novice nurses were explored through in-depth interviews, telephone and video conferencing interviews. All interviews were recorded, verbatim transcribed and analysed by thematic content analysis.
Results:
The findings fell into five main themes as follows: from novice nurses to nurse who care for COVID-19 patients; various learning methods focused on providing care to COVID-19 patients; work experiences and confrontations with COVID-19; various feelings that arise when being a nurse caring for patients with COVID-19; the power of novice nurse to bring along positive changes.
Conclusions:
The study provides an understanding of novice nurses' experiences when caring for COVID-19 patients. It also highlights the stress, fear and anxiety of novice nurses during the pandemic and suggests novice nursing practice training systems to enhance their familiarity and confidence when dealing with situations during the pandemic. The novice nurses were found to demonstrate a large amount of self-determination and possess several technological skills and innovative abilities to improve the nursing practice and quality of care.
... Furthermore, most hospitals' new-hire onboarding programmes focus on hospital and nursing policies and workflows, infection control, environmental and safety culture, emergency procedures, patient communication, incident reporting, and education courses on specific skills required of the area of practice. 54 Little emphasis is placed on the culture of nursing collaborative practice and delegation. ...
Background:
Nurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards.
Objectives:
The aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings.
Methods:
A qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed.
Findings:
Three main themes emerged from the data analysis. The first, "reaching a collective understanding of patients' conditions', identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, "role expectations of each other", describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, "lacking in shared decision-making", depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care.
Conclusions:
A less-than-optimal collaborative EN-RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN-RN collaborative practice. Nurse managers and educators are instrumental in fostering EN-RN collaboration and providing ongoing education on nursing teamwork skills and competencies.
... In an early review, FitzGerald et al. (2001) examined transition support for new graduates. More recently, Edwards et al. (2015) completed a systematic review of 30 quantitative studies on the effectiveness of support strategies for new graduate transition, and Pertiwi and Hariyati (2019) identified 14 studies in a review on effective orientation programmes in hospital settings. In other systematic reviews, Chappell and Richards (2015) explored the link between new graduate transition programmes and clinical leadership. ...
Objective
The aim of this mixed methods systematic review was to: i) document the interventions that support and facilitate graduate nurse transition from university to practice in a diversity of healthcare settings and ii) to identify outcomes from graduate nurse transition interventions for the graduate, patient or client, and health service.
Design
This mixed methods systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria.
Data sources.
Primary research studies located in Medline, EmBase, CINAHL, Prospero, Cochrane Library, PsycInfo, and Web of Science (Social Science Citation Index). All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria.
Review methods.
Using a comprehensive search strategy, retrieved articles were screened by two reviewers at the title, abstract, and full-text stage. Reviewer disagreements were discussed until consensus was achieved. The well-validated Mixed-Methods Appraisal Tool was used to assess quality of the quantitative, qualitative, and mixed methods studies.
Results
A total of 130 studies were included as the review dataset. There was a myriad of terms used to describe transition interventions, and programme length and settings varied. The content of transition interventions was not well defined, and there was a lack of studies outside acute hospital settings. Data collection methods varied widely. The majority of authors reported outcomes for the graduate or the graduate and service, with only one reporting outcomes for the patient or client. There was a significant variation in quality across the studies.
Conclusions
This review addresses a significant gap in the literature by documenting transition interventions in a diversity of health settings and outcomes from these interventions. Interest in transition to practice continues to rise, but there is an urgent need to conduct well designed, robust, and larger-scale studies at the national and transnational levels.
... Onboarding, when referred to in nursing literature, refers to the professional orientation of new registered nurses in workplace settings and not in higher education. [11] Zeeman, Wingo, & Cox [8] evaluated a learner-centered orientation program meant to assist the transition of students to a Doctor of Pharmacy (PharmD) program. Learner-centered orientation is a customized orientation experience, with the goal of preparing first-year students for a proactive curriculum that promotes meaningful, self-directed learning. ...
Background and objective: Nurses who return to school to obtain higher education come with varying levels of professional, educational and technological competencies. Some are new graduates, others have not been in school for a decade, and several find educational technology difficult to navigate. Returning to school can be challenging because graduate programs require complex skills in order for students to succeed. Onboarding, the process of organizational socialization, also known as the orientation process, is a relevant element in the retention and progression of students in graduate education. Onboarding differs from school to school, ranging from half a day to a weeklong on-campus orientation. This research is about a structured onboarding program built into a graduate nursing course and specifically addresses the needs of students in order to succeed in their studies. This research presents insights into the Graduate Student Onboarding – Professional Development Program (GSO-PDP), a structured onboarding designed to assist graduate nursing students with their adjustment back to school, enhance their learning, and achieve their graduate degree successfully. It is built into the Nursing Informatics class and is a month-long process. The research offers some understanding of the usefulness of the GSO-PDP to incoming graduate nursing students.Methods: The study uses the qualitative paradigm, in particular, a case study design. This is an examination of the four modules of the GSO-PDP: Elements of Research, Scholarly Writing and Nursing Documentation, Academic Support Services, and Student Life. Student volunteers participated in focus group interviews to evaluate the program. Results: The following were recurring themes identified from focus group interviews: “APA Refresher Overload,” “Bridging the Gap,” “Relearning English Grammar,” “Navigating the Learning and University Maze,” and “Not Really Computer Savvy.” It is evident that most of the elements of the GSO-PDP are beneficial to students in enhancing their adjustment and return to school for further education. The onboarding program also facilitates and enhances student learning. Focus group participants offered some helpful recommendations to improve the program.Conclusions & Implications: This is an innovative and structured onboarding approach to help students with diverse backgrounds to succeed in the Master’s program. Participants generally described the program favorably, but did make suggestions for improvement.
... The results revealed that the orientation program had a significant impact on nurse competence. This is consistent with previous reports [25][26][27], which reveal that orientation programs have a positive effect on nurse competence. The findings of the focus group show that overall, the participants achieved good competence. ...
Objectives
Competence motivates newly employed nurses to provide high-quality care, which leads to appropriate patient care and satisfaction. A nursing orientation program can have a positive impact on new nurses who are joining healthcare organizations. The research examined the orientation program for new nurses in a multicultural setting to redesign the program.
Methods
The study was carried out in a multicultural tertiary setting. Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. Seventy nurses were part of the orientation program. The competence of the nurses was assessed using the Nurse Competence Scale. Focus-group discussions were also conducted to find the views of the beneficiaries about the program.
Results
The study revealed that the overall competence was high, and there was an overall gain in the competence score (5.48%) among the nurses. Among their competence in different dimensions, new nurses had a maximum gain in competence for the dimension of ensuring quality. However, they showed low competence gain in teaching coaching. The results show that the difference in the overall pre- and post-test scores was statistically significant (P < 0.05) in all dimensions except teaching coaching and managing situations, and the program was effective. However, a few challenges were identified in the program.
Conclusions
New nurses were found to be competent, and the orientation program had a significant impact on the competence of the nurses. The findings emphasized the need for modification of some content and strategy for future programs. The strategies developed from the findings were presented. This helps hospitals to consider examining specific aspects of the orientation program and redesigning it so it can enrich the experiences of new nurses.
Purpose
Recovery-focused mental health treatment continues to grow, yet staff are often uncertain how best to define and implement it. As a quality assurance activity, we examined the effect of a novel orientation program embedded with a recovery framework structure, philosophy, and content, together with true lived experience codesign, on knowledge of recovery principles and acceptability.
Method
Staff of a new sub-acute adolescent mental health inpatient center completed a 6-week orientation in early 2020. Recovery processes of connectedness, hope and optimism, identity, meaning, and empowerment were mapped to session topics and the structure, design, and philosophy of the program.
Results
Mean knowledge scores improved from pre- to post-assessment and most (≥70%) participants reported topics as relevant, impactful, and would recommend. Approximately all (95%) comments were positive.
Conclusion
Findings suggest that person-centered orientations that embed a recovery framework are promising for mental health staff orientation. [ Journal of Psychosocial Nursing and Mental Health Services, xx (xx), xx–xx.]
Background: Compressing the knowledge and skills of speciality care nursing, such as perioperative nursing, within a few weeks is not feasible as such knowledge and skills require months and years of training to be attained and proficient. It has, in turn, impacted OR nurses professionally. Objective: This study aimed to explore the impacts of OR nursing induction programmes (IPs) on newly-joined nurses (NJNs) in Singapore OR units. Design: This mixed-methods study included two phases. Phase one used an online questionnaire survey via Google Forms to collect data from 91 OR nurses using 42 items questionnaire survey. In the second phase, eight nurses from phase one were recruited for a Zoom interview to gather more insights regarding the main findings from phase one. Results: The survey revealed five main areas of OR nursing IPs that impacted NJNs in their job role. These include ‘contents’, ‘delivery’, ‘length’, ‘resources’ and ‘seeking clarifications’. Four themes emerged from the interview: ' quality of IP’, ‘skills and knowledge acquisition’, ‘adapting to a new clinical environment’ and ‘resource persons during IP’, which were associated with OR nursing IPs' impacts on NJNs in Singapore. Conclusions: The central challenge identified in this study impacted OR nurses' job role as contributors to knowledge and skills acquisition. Ultimately, nurses in this study expressed that their resilience and initiative to seek clarifications reduced the challenges that impacted their role performance after their IPs.
Purpose
The recruitment of international nurses has been used for a long time to address the global nurse shortage. In 2012, the employment of international nurses was released in Turkey. Cultural differences can hinder interpersonal relationships, and fostering strong interpersonal relationships among nurses in the workplace is known to have a positive impact on productivity, job satisfaction and the quality of care provided. This study aims to explore the lived experiences and perceptions of international nurses working in Turkey regarding their professional integration and interpersonal relationships in the workplace.
Design/methodology/approach
It is a qualitative descriptive study. Face-to-face interviews were conducted with 19 international nurses using a semi-structured form. Data were analyzed using thematic analysis.
Findings
Data were presented into two themes: (1) Interpersonal relationships in the workplace and (2) Professional integration. Participants reported positive and negative experiences regarding interpersonal relationships in the work environment, such as warm and supportive approaches, or exclusionary and discriminatory behaviors. The existence of different nursing practices, positive and negative factors concerning orientation programs and the gain of experience and professional satisfaction were mentioned by the participants.
Originality/value
This is the first study to explore the lived experiences and perceptions of international nurses working in Turkey. The study highlights the unique needs and challenges faced by international nurses during workplace adaptation and provides practical recommendations to facilitate interpersonal relationships in the workplace and other aspects related to professional integration from hiring to the end of the adaptation period.
Background:
Graduate nurses are known to experience transition shock when they enter the workforce. Graduate nurse programs are designed to alleviate aspects of transition shock.
Method:
Best practice in development and delivery of transition programs is currently limited in the literature, and there are few examples focusing on curriculum design that can be adapted by health services to develop and support new nurses.
Results:
An inquiry-based learning approach was used as the underlying andragogy to frame a contemporary transition curriculum to support graduate nurses.
Conclusion:
Inquiry-based learning can be used to support graduate nurses to improve critical thinking, confidence, and job satisfaction during the most challenging years of their professional lives. [J Contin Educ Nurs. 2023;54(6):268-274.].
Background:
Adequate mentoring and support of community service nurses (CSNs) in transitioning from the learning environment to the public health setting is pivotal. Despite this notion, the mentoring of CSNs is inconsistently implemented. It was therefore imperative that the researchers developed the guidelines that can be used by managers to mentor the CSNs.
Aim:
This article shares nine guidelines to ensure adequate mentoring of CSNs in public health settings.
Setting:
The study was conducted in public health settings designated for placement of CSNs, in South Africa.
Methods:
This study followed a convergent parallel mixed-methods design whereby qualitative data were obtained from purposefully selected CSNs and nurse managers. Quantitative data were obtained from 224 CSNs and 174 nurse managers, with the use of mentoring questionnaires. Semi-structured interviews were used on focus groups of nurse managers (n = 27) and CSNs (n = 28). Quantitative data were analysed with Statistical Package for Social Science software version 23, ATLAS.ti 7 software was used to analyse qualitative data.
Results:
The merged results evidenced that CSNs were not adequately mentored. The public health setting was not conducive to mentoring CSNs. Mentoring activities were not well structured. Monitoring and evaluation of mentoring of CSNs were not properly done. Evidence from merged results and literature were applied to develop mentoring guidelines for operationalising a mentoring programme for CSNs.
Conclusion:
The guidelines were: (1) creation of a positive mentoring environment, (2) enhancement of collaboration between stakeholders, (3) attributes of CSNs and nurse managers in the mentoring relationship, (4) enhance orientation for nurse managers and CSNs, (5) facilitation of mentor-mentee matching process, (6) conducting mentoring meetings, (7) capacity development for CSNs and nurse managers, (8) monitoring and evaluation of mentoring process, and (9) reflections and feedback.
Contribution:
This was the first CSNs' guidelines to be developed in the public health setting. These guidelines could facilitate adequate mentoring of CSNs.
Background: Adequate mentoring and support of community service nurses (CSNs) in transitioning from the learning environment to the public health setting is pivotal. Despite this notion, the mentoring of CSNs is inconsistently implemented. It was therefore imperative that the researchers developed the guidelines that can be used by managers to mentor the CSNs. Aim: This article shares nine guidelines to ensure adequate mentoring of CSNs in public health settings. Setting: The study was conducted in public health settings designated for placement of CSNs, in South Africa. Methods: This study followed a convergent parallel mixed-methods design whereby qualitative data were obtained from purposefully selected CSNs and nurse managers. Quantitative data were obtained from 224 CSNs and 174 nurse managers, with the use of mentoring questionnaires. Semi-structured interviews were used on focus groups of nurse managers ( n = 27) and CSNs ( n = 28). Quantitative data were analysed with Statistical Package for Social Science software version 23, ATLAS.ti 7 software was used to analyse qualitative data. Results: The merged results evidenced that CSNs were not adequately mentored. The public health setting was not conducive to mentoring CSNs. Mentoring activities were not well structured. Monitoring and evaluation of mentoring of CSNs were not properly done. Evidence from merged results and literature were applied to develop mentoring guidelines for operationalising a mentoring programme for CSNs. Conclusion: The guidelines were: (1) creation of a positive mentoring environment, (2) enhancement of collaboration between stakeholders, (3) attributes of CSNs and nurse managers in the mentoring relationship, (4) enhance orientation for nurse managers and CSNs, (5) facilitation of mentor–mentee matching process, (6) conducting mentoring meetings, (7) capacity development for CSNs and nurse managers, (8) monitoring and evaluation of mentoring process, and (9) reflections and feedback. Contribution: This was the first CSNs’ guidelines to be developed in the public health setting. These guidelines could facilitate adequate mentoring of CSNs.
Background
This research is motivated by the fact that medication errors are serious threats to the safety of patients in hospitals. Nurses are one of the health workers who play a significant role in preventing these errors.
Objective
The aim of this quantitative research is to determine the factors that influence the incidence of medication errors by nurses.
Methods
The adopted method had a correlative descriptive design and used samples obtained from 164 nurses through a purposive sampling technique. The sample inclusion criteria were the nurses who worked in patient’s rooms, those who were healthy and not sick, not currently in school, and were willing to be respondents. Furthermore, the research instruments were questionnaires, which were developed through the Cronbach's alpha validity and reliability test results of 0.681 and 0.873, respectively. Analysis was conducted using the independent t test, X ² (chi-square) and multiple logistic regressions.
Results
The results showed that the factors which influenced the incidence of medication errors were work experience, motivation, workload, managerial and environmental elements. Moreover, the variable which contributed the most, with a p -value of 0.004 and OR of 5.387 was workload.
Conclusion
Finally, the following factors, including nurse's workload, motivation, work experience, good managerial management and environmental elements, should be considered when preventing medication errors.
Purpose
The purpose of this study was to investigate newly graduated nurses' educational needs for web-based simulation (WBS) education.
Methods
A cross-sectional descriptive study was conducted with 132 registered nurses, regardless of their career length, working at a hospital in Korea. Data accrued through a self-reported questionnaire asking nurses about their educational needs. Data were analyzed using descriptive statistics, independent t-test ANOVA, and Scheffe test.
Results
Almost all (96.2%) participants said that new nurses need simulation training, and 90.2% of participants said WBS is necessary. The highest ranked category was fundamental nursing knowledge, followed by fundamental nursing technique. Among 81 items of nursing education needs, top ranked items were cardiopulmonary resuscitation, care of artificial airways, oxygen therapy, and mechanical ventilation, which were mostly in the fundamental-nursing-techniques category. Educational needs significantly differed depending on participants' clinical experience (F = 5.37; p = .006), hospital types (t = −3.48; p = .001), and past experiences as a preceptor (t = 2.71; p = .008). Participants with 4 to 6 years of clinical experience, working in a hospital with more than 300 beds, and with experience as a preceptor, answered that new nurses have high educational needs WBS.
Conclusions
WBS for new nurses should include fundamental nursing knowledge and techniques that can apply to clinical practice immediately after learning. Also, emergency nursing care should be included to prioritize adequately and cope with emergency situations. The use of WBS will help new nurses learn and adapt to the clinical setting, which can assist nurses in providing optimal care to patients with confidence.
Aim: To explore the experiences of graduate nurses enrolled in a transition program, to gain insight into what graduates experienced as beneficial, as barriers and to seek meaning to the phenomena of transition as experienced within a transition program. Background: A graduate nurse's transition to professional practice is a time of high emotion where graduates leave the familiar grounds of university for the unknown of professional practice. Numerous studies, spanning many decades, have investigated issues regarding transition leading to the development of transition programs to aid the recognised burden. Method: The researchers used principles of hermeneutic phenomenology to explore the language used in semi-structured interviews of seven graduate nurses undertaking a Transition to Professional Practice Program in an Australian metropolitan hospital to investigate the lived experiences of transition within a transition program. Results: Thematic analysis of transcribed interviews revealed that transition from student to professional is a time of many new demands that causes shock and can lead to negative emotions. However, many constructive responses and positive emotions were also present. These responses included positive feelings in the care of patients and of support received by graduates from dedicated educators linked to the transition program and by senior nurses on the ward. Conclusion: Transition to practice is an important stage in the career of a Registered Nurse and the transition issues related by graduate nurses in this study corresponded with issues raised in similar transition literature suggesting that continued work is required. However, the benefits of dedicated staff in aiding transition as expressed by the participants of this study is a positive affirmation of the advantages of graduates being enrolled in a transition program.
Purpose
– The purpose of this paper is to explore the perceptions of new nurses in Singapore of their experiences of role transition and to examine the implications for managers in terms of employee training, development and retention.
Design/methodology/approach
– This qualitative study was conducted using a constructivist grounded theory approach. In total 26 novice nurses and five preceptors (n=31) from five different hospitals participated in the study. Data were collected from semi-structured interviews and reflective journal entries and analysed using the constant comparative method.
Findings
– The findings revealed that novice nurses remained emotionally and physically challenged when experiencing role transition. Two major constructs appear to play an important part in the transition process; learning how to Fit in and aligning personal with professional and organisational identities. The findings highlight factors that facilitate or impede Fitting in and aligning these identities.
Originality/value
– Although the concept of Fitting in and its relation to the attrition of novice nurses has been explored in global studies, that relationship has not yet been theorised as the dynamic alignment of multiple identities. Also, whilst most research around Fitting in, identity and retention has been conducted in western countries, little is known about these issues and their interrelationship in the context of Singapore. The study should inform decision making by healthcare organisations, nurse managers and nursing training institutions with respect to improving the transition experience of novice nurses.
Background:
There is a need for effective orientation programs that are designed to prepare new graduate nurses in providing safe, competent, and effective patient care. However, little is known regarding the overall effectiveness of these programs for nursing graduates.
Objectives:
To determine whether the transition of the graduates into their working place included a structured orientation program, and to assess the effectiveness of the program from the graduate's perspective.
Design:
Cross-sectional survey design.
Settings, participants, and methods:
Data were collected from four different institutions in Israel. A questionnaire was divided among 100 graduate nurses and had a response rate of 79%. A questionnaire was designed and included closed and open questions. It was evaluated for internal consistency by standardized Cronbach's alpha coefficients (Cronbach's alpha was between 0.91 and 0.96).
Results:
Only 50.6% of the nurses in the sample reported having a structured orientation program. We found positive significant correlations between having a structured orientation program to adaptation of the graduate nurses to the ward, satisfaction of the graduates on the ward. Positive correlations were also found between support that the graduates received to their satisfaction on the ward. Retention on the ward was highly correlated with having a program, satisfaction, adaptation, and support. We found differences in acclimation indices by religiosity.
Conclusions:
Different delivery approaches of orientation programs may determine satisfaction of the graduates. A transition program which overlooks individual needs or an informal individual approach may lead to dissatisfaction. A program which is "tailored" to the graduate, by an assigned one-to-one appointment of a preceptor, may lead to satisfaction, which in turn may assure an ongoing supply of competent RNs who will remain in those settings.
New graduate registered nurses (NGRN's) have an expectation of clinical support as they make the transition from novice to advanced beginner. In this 2008-2009 study of three rural transition to practice programs we found that clinical support did not eventuate. Consequently, NGRN's reported feeling underprepared for practice, overwhelmed by responsibility and often abandoned. Against this background, many were concerned that their inexperience had implications for safe patient care. Graduate nurse transition programs need to have the physical and human resources necessary to deliver the clinical support as promised in their prospectus, to ensure patient safety. This grounded theory study identified three essential core elements - leadership support, clinical supervision, and effective interprofessional relationships. Recommendation is made to address these deficits by mandating their inclusion in all transition to professional practice programs.
Literature shows that successful transition of newly graduate nurses to professional nurses is imperative but does
not always take place, resulting in difficulty in performance, cognizance or behaviour of a role as a nurse,
affecting the quality of patient care negatively. No integrative literature review could be found to summarize
available guidelines facilitating transition of final year nursing students to professional nurses. An extensive
search of the literature by means of an integrative literature review was conducted in 2014 and updated in June
2017, following a five-step process. All relevant studies were subsequently appraised for rigour and quality using
the AGREE II tool by two independent reviewers. Eight (n=8) guidelines on transitions were independently
extracted. After thematic analysis was done, three factors to facilitate transition of final year nursing students to
professional nurses were found: 1) support for new graduates, 2) the graduate's need for socialization and belonging,
and 3) a positive clinical learning environment. The availability and implementation of guidelines on
transition of final year nursing students by educational institutions and healthcare facilities could ease the
transition from being final year nursing students to becoming professional nurses as well as improve retention of
newly qualified professional nurses.
Background
With dwindling nursing student placements in acute care facilities, increased pressure and responsibility have been placed on students to facilitate their transition to practice. Through the strategy of simulation-based orientation programs, the preparation to practice gap can be reduced.
Methods
In 2013, London Health Sciences Centre embarked on a quality improvement initiative to revise their Central Nursing Orientation through the use of simulation and experiential learning.
Results
Five hundred twenty-one new nurse hires participated in the revised orientation program and were compared with 749 who participated in the original program. New nursing hires commented on improved confidence and preparation for the unit. Summative assessments resulted in 23.4% of new hires unsuccessful in their first attempt, 6% in their second attempt, and 0.5% in their third.
Conclusions
The successful development of a simulation-based orientation program provided our new nursing hires with a standardized approach for a successful transition to practice. Through this process, we also identified the continued learning needs during transition and the opportunity to engage with our academic institutions to better prepare our future nurses.
The aim of this project was to evaluate the effectiveness and outcomes of a redesigned newly licensed nurse orientation program. A unique aspect of this program was an end-of-orientation simulated four-patient assignment that was designed to assess five categories of critical thinking: prioritization and delegation, problem recognition, clinical decision making, clinical implementation, and reflection. Newly licensed nurses' critical thinking was measured by the Advisory Board's Critical Thinking Diagnostic tool at 10 weeks, 6 months, and 12 months. Findings showed that in all five categories of critical thinking, a significant increase was found between the 10-week and 6-month evaluation. Two of the categories—prioritization and delegation, and problem recognition—were found to have a significant increase from the 6-month evaluation to the 12-month evaluation. In addition, newly licensed nurses reported improvement in their confidence and in their preparation to work independently.
J Contin Educ Nurs. 2017;48(1):22–28.
Purpose:
The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area.
Description of project:
All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues.
Outcome:
All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA.
Conclusion:
Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.
Professional confidence is an essential trait for new graduate nurses to possess in order to provide quality patient care in today's complex hospital setting. However, many new graduates are entering the workforce without it and this remains to be explored. This study describes how new graduate nurses accounted for their lack of professional confidence upon entry into professional practice and how it developed during their first year of practice in the hospital setting. Two face-to-face, individual interviews of 12 participants were utilized to capture the lived experiences of new graduate nurses to gain an understanding of this phenomenon. After manual content analysis seven themes emerged: communication is huge, making mistakes, disconnect between school and practice, independence, relationship building, positive feedback is important, and gaining experience. The findings indicate that the development of professional confidence is a dynamic process that occurs throughout the first year of practice. New graduate nurses must experience both positive and negative circumstances in order to move toward the attainment of professional confidence. Knowing this, nurse educators in academia as well as in the hospital setting may better support the development of professional confidence both before and during the first year of practice.
Unlabelled:
The first year of practice as a nurse is recognized as stressful. Graduate nurses (GNs) report gaps in their education, reality shock, burnout and other negative experiences that influence their intentions to remain in nursing.
Objectives:
The aim of this literature review was to gain a greater understanding of the experiences of GNs.
Review methods:
It included thirty-six articles that focused on GNs and their transition to nursing, as part of a graduate nurse program (GNP), from 2005 to present.
Result:
The review identified three main themes that influence the transition from student to registered nurse. These themes included, 1) feeling stressed and overwhelmed by nursing responsibilities, 2) the amount of support from senior nurses and 3) the importance of feedback on their performance as nurses.
Conclusions:
Further research that is focused on the support and feedback provided to new nurses is needed.
Aim:
This study aimed to describe the research on registered nurses' orientation processes in specialized hospital settings in order to illustrate directions for future research.
Background:
The complex healthcare environment and the impact of nursing shortage and turnover make the hospital orientation process imperative. There is a growing recognition regarding research interests to meet the needs for evidence-based, effective and economically sound hospital orientation strategies.
Methods:
An integrative literature review was performed on publications from the period 2000 to 2013 included in the CINAHL and PubMed databases. English-language studies were included. Themes guiding the analysis were definition of the hospital orientation process, research topics, data collection and instruments and research evidence. Narrative synthesis was used.
Results:
Eleven papers met the inclusion criteria. The conceptualization of orientation process reflected the complexity of the phenomenon. Less attention has been paid to designs to establish correlations or relationships between selected variables and hospital orientation process. The outcomes of hospital orientation programmes were limited primarily to retention and job satisfaction. The research evidence therefore cannot be evaluated as strong.
Conclusion:
The lack of an evidence-based approach makes it difficult to develop a comprehensive orientation process. Further research should explore interventions that will enhance the quality of hospital orientation practices to improve nurses' retention and job satisfaction.
Implications for nursing and health policy:
To provide a comprehensive hospital orientation process, hospital administrators have to put in place human resource development strategies along with practice implications and research efforts. Comprehensive hospital orientation benefits and outcomes should be visible to policy makers.
The graduate nurse internship program was developed on the basis of Watson's Human Caring Theory. In this article, the author discusses how an orientation program was formalized into an internship program and how the theory was applied.
IntroductionProfessional nurse educators in acute care are challenged to increase the level of clinical performance of new graduate nurses. There is little research on the most effective method available to facilitate this process completed the quasi-experimental pilot study.Method
This quasi-experimental pilot study compared the clinical performance, satisfaction with orientation, and employment outcomes of two groups of new graduate nurses: one group completing human patient simulation (HPS) scenarios and one group completing written case studies on the same complex clinical cases. The stratified purposive sample included twenty new graduate nurses.ResultsThere were no differences in satisfaction with orientation or retention between the two groups. There were no differences in assessment, interventions, or communication performance between the two groups. The experimental group (HPS) performed better on safety behaviors than the control group (written case studies).Conclusions
The pilot data on safety performance provided insights for a larger study comparing these two teaching methods.
To examine the relationships between selected components of new graduate nurse transition programmes and transition experiences.
Transition support for new graduates is growing increasingly multifaceted; however, an investigation of the effectiveness of the constituent components of the transition process is lacking.
An online survey was disseminated to new graduates working in acute care settings and included questions related to new graduate transition programmes. The Casey Fink Graduate Nurse Experience Survey was used to quantify the transition experience.
New graduate nurses who participated in a formal new graduate (NG) transition programme had significantly higher total transition scores than non-programme nurses. The orientation length and the average number of hours worked in a two week period were significant predictors of transition; the percentage of preceptored shifts was statistically insignificant.
New graduate transition is enhanced with participation in a formal transition programme. Orientation should be at least four weeks in length, and new graduates should work at least 49 hours in a two week period.
Nurse managers are in key positions to advocate for new graduate nurse transition programmes with adequate resources to support a four week orientation phase and shift scheduling to ensure an adequate number of hours over two week periods to facilitate transition.
This article presents research results applying Peplau's Theory of Interpersonal Relations to the preceptor-new graduate relationship and describes implications for successful transition. These results will help nursing professional development educators with more appropriate preparation and assignment of preceptors.
This qualitative study presents the transition experience of new registered nurses during the first year of professional practice. Four themes emerged: feelings of frustration and being overwhelmed, preceptors, fear, and the orientation process. The orientation process, quality, competent preceptors, and reducing lateral violence are key strategies to successfully retain new nurses. Nurse educators have a crucial role during nurse orientation, training preceptors, and reducing violent behaviors in the workplace.
Nurse residency programs are designed to support graduate nurses as they assume the professional role. Evaluation of these programs has been inconsistent. The purpose of this descriptive research study was to evaluate a year-long nurse residency program using a nonexperimental, repeated measures design with qualitative questions. Results showed statistically significant differences in new nurse confidence, skills, and abilities at 12 months. Nursing turnover was one third of the national average. The metatheme that emerged from the data was "I see that I am not the only one."
hillman l. & foster r.r. (2011) Journal of Nursing Management 19, 50–56 The impact of a nursing transitions programme on retention and cost savings
Aim To identify the benefits and essential elements of a new graduate residency programme.
Background Retention of nurses is a global nursing concern. New graduate nurses have the lowest retention rates and, therefore, the present study focused on the unique needs of this group.
Evaluation Valid and reliable tools were utilized to evaluate work satisfaction, clinical decision making, organizational commitment and skill development during and after each residency. We also compared resident retention and associated cost savings.
Key issues The adoption and implementation of the residency programme represented a change in culture. Hiring and education practices for new nurses changed dramatically.
Conclusions Before the development of a new graduate transition programme, our 1-year retention rate was as low as 50%. Five years after programme adoption, retention increased to 72.5%, resulting in major cost savings to the organization.
Implications for nursing management Nursing Management must be creative and transformational in their thinking in order to address nursing retention. Implications for nurse managers who are considering residency programmes include the potential for significant cost savings for the hospital, increased resident, nursing and unit satisfaction and a demand for nurses who desire to work at their hospitals.
This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear.
Transition into the workforce for the new graduate nurse is affected by many factors. New graduate nurses can benefit from support provided through participation in the UHC/AACN Residency Program. The retention of even one graduate nurse saves the employing institution up to an estimated $80,000 annually. St Joseph's Hospital has improved the retention of new graduate nurses from approximately 40% to 100% with the addition of the UHC/AACN Residency Program alongside other system changes. Data are being monitored at St Joseph's and on a national level through this multisite collaborative aimed at improving patient care and increasing nurse retention.
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.
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.
Clinical competencies, anxiety, stress, professional transition and retention were measured on 55 nurse residents who have participated in the nurse residency programme.
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%.
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.
Research shows that simulation is an effective teaching strategy in the preparation of healthcare professionals. Simulation is often used to evaluate clinical judgment and competencies of students. It has been proposed that simulation can be used during orientation to assist graduate nurses as they transition to professional roles. The purpose of this article is to provide a summary of current evidence related to the use of simulation in graduate nurse orientation. An integrative review was conducted using guidelines set forth by Ganong (Ganong, Res Nurs Health. 1987;10:1-11). Three articles meeting the inclusion criteria were analyzed, and three themes were identified: socialization to the professional role, competence and confidence in self-performance, and learning in a safe and supportive environment. In this article, additional findings from the literature are linked to the three themes. Recommendations for future research are suggested.
The aims of this study were to measure job satisfaction and engagement perceptions of new nurses after completing interactive residency modules and to test the reliability and validity of the Halfer-Graf Job/Work Environment Nursing Satisfaction Survey.
US nursing shortages are estimated to increase to 36% by 2020, requiring emphasis on hiring new graduate nurses. Improved retention of new graduates through innovative orientations such as interactive nurse residencies is one option.
This mixed qualitative and quantitative study compared perceived job satisfaction and employee engagement of 90 new graduate nurses completing an interactive nurse residency.
Reliability and validity of the Halfer-Graf tool were supported. Qualitative analysis yielded trends related to satisfiers (patients, patient outcomes, and teamwork) and dissatisfiers (staffing/scheduling, lack of teamwork, and physician disrespect). Simulation scenarios, debriefing, and e-mail communication with peers ranked high as beneficial teaching strategies.
Study findings support previous research. An interactive learning environment was perceived as beneficial. First and second year nurse retention was consistent with previous residency programming.
Graduate nurses experience role conflict and stress as they begin practice in work environments of high complexity, nurse shortages, and expectations to become competent rapidly. The authors report outcomes from a study that evaluated qualitative responses to the Casey-Fink Graduate Nurse Experience Survey administered to graduate nurse residents in the University HealthSystem Consortium/American Association of Colleges of Nursing postbaccalaureate nurse residency program at 12 academic hospital sites. Qualitative analysis provided sufficient evidence to convert specific open-ended questions on the Casey-Fink Graduate Nurse Experience Survey instrument to a quantitative format for ease of administration and analysis.
This study investigated the influence of personal factors, orientation, continuing education, and staffing shortage on the satisfaction, intent to leave their job, and intent to leave the profession of a random sample of new graduate nurses from varied facilities and geographic locations. It further examined the influence of personal factors and orientation on turnover rates among new graduate nurses. The findings indicate that orientation programs are essential to the retention and satisfaction of new graduate nurses. Given current economic constraints, this study supports nurse executives' ability to advocate for and receive funding for transition-to-work programs as well as the placement of new graduate nurses in well-staffed units.
The helpfulness and timing of transition program education
- K L Rush
- M Adamack
- R Janke
Rush KL, Adamack M, Janke R. The helpfulness and
timing of transition program education. J Nurses Prof
Dev.
2013;29:191---6,
http://dx.doi.org/10.1097/NND.
0b013e3ec431829.
Transition to practice study in hospital settings
- N Spector
- M A Blegen
- J Silvestre
Spector N, Blegen MA, Silvestre J, et al. Transition to practice study in hospital settings. J Nurs Regul. 2015;5:24---38,
http://dx.doi.org/10.1016/S2155-8256(15)30031-4.
- D Wijaya
Wijaya D [Unpublished thesis] Hubungan program orientasi
berbasis kompetensi dengan kinerja perawat baru di rawat
inap Rumah Sakit Husada Jakarta. Depok: Universitas Indonesia;
2010.