No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The novice nurse and clinical decision-making: How to avoid errors
Journal of Nursing Management
Abstract
The purpose of this integrative review is to present the evidence in relation to novice nurses' errors when faced with clinical decision-making in the first years of a nursing career.
Recent studies identify a need for nursing schools to produce 30,000 new graduates each year to keep up with the nursing shortage. Novice nurses may be at greater risk for errors than experienced nurses. As the novice nurse moves into practice, it is imperative to recognize potential mistakes in order to prevent errors.
Articles selected included information regarding types of errors, causes of errors and potential interventions for the novice nurse.
The primary types of errors committed by the novice nurses include medication errors, patient falls and delay in treatment. The causes of such errors are complex.
Improved patient outcomes, reduced liability and higher retention/satisfaction are all potential benefits of reducing the errors made by novice nurses. Simply being aware of the type of problems may be an important first step in improving the care by novice nurses.
... The lack of critical thinking in student nurses and new graduates has been a concern to the nursing profession. It would negatively affect the quality of service and directly relate to the high error rates in novice nurses that influence patient safety (Arli et al., 2017;Saintsing et al., 2011). It was reported that as many as 88% of novice nurses commit medication errors with 30% of these errors due to a lack of critical thinking (Ebright et al., 2004). ...
... It was reported that as many as 88% of novice nurses commit medication errors with 30% of these errors due to a lack of critical thinking (Ebright et al., 2004). Failure to rescue is another type of error common for novice nurses, reported as high as 37% (Saintsing et al., 2011). The failure to recognize trends or complications promptly or take action to stabilize the patient occurs when health-care providers do not recognize signs and symptoms of the early warnings of distress (Garvey and CNE series, 2015). ...
... A major concern in the nursing profession is the lack of critical thinking in student nurses and new graduates, which influences the decision-making of novice nurses and directly affects patient care and safety (Saintsing et al., 2011). Nurse educators must use evidence-based practice to prepare students to critically think with the complicated and constantly evolving environment of health care today (Goodare, 2015;Newton and Moore, 2013). ...
Purpose
The lack of critical thinking in new graduates has been a concern to the nursing profession. The purpose of this study was to investigate the effects of an innovative, evidence-based skills fair intervention on nursing students' achievements and perceptions of critical thinking skills development.
Design/methodology/approach
The explanatory sequential mixed-methods design was employed for this study.
Findings
The findings indicated participants perceived the intervention as a strategy for developing critical thinking.
Originality/value
The study provides educators helpful information in planning their own teaching practice in educating students.
... High attrition rates and increasing costs of new graduate orientation are consistent with ineffective responses in nursing (Pinchera, 2012). Many studies suggest unpreparedness contributes to the high rate of care errors by new nurse graduates (Benner et al., 2010;Culleiton, 2010;Saintsing, Gibson, & Pennington, 2011). Ineffective responses such as errors foster feelings of inadequacy and frustration, undermining professional relationships and successful professional development (Pinchera, 2012). ...
... Despite ongoing improvements in nursing education, 21st-century nurses enter the complex health-care environment without the skills and knowledge needed to practice (Benner et al., 2010). An estimated 25% of new graduate nurses lack critical reasoning and problem-solving skills, leaving them unable to provide safe patient care (Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2009;Saintsing et al., 2011). These nurses lack the capacity to maintain and enhance the knowledge base for continued safe, high-quality patient care (Benner et al., 2010). ...
The purpose of this research was to identify nursing faculty behaviors that reduced the stress and anxiety experienced by new graduate nurses as they transcended from the role of student to professional registered nurse. New graduate nurses often go through a period of high anxiety and stress as they adapt to the role of professional nursing. Known as role transition, many new graduate nurses have difficulty remaining employed and leave the profession of nursing. Staff educators in the health-care industry have worked on developing orientation programs targeted at reducing the anxiety and stress experienced by new graduate nurses. Nursing faculty in academia have worked to provide student nurses with the education needed to practice in an ever-evolving complex health-care system. Despite efforts to provide the education needed, role transition remains a relevant barrier in the ability of many nurses to adjust from the role of student to professional registered nurse. Once specific behaviors were identified, a beginning theory was developed. The beginning theory was developed from the five categories derived from the coding process. They are caring, rigor, experience, knowledge, and professionalism. The purpose of the beginning theory is to provide guidance for nursing faculty as they prepare students for professional practice.
... Registered nurses (RN) who enter a new professional practice encounter an array of challenges and emotions (Henderson et al., 2015). Independently of whether it is a case of RNs being completely new to the profession or experienced RNs entering a new speciality, it is considered a vulnerable time, and it is during this time that the majority of clinical mistakes and medical errors are made (Saintsing et al., 2011). ...
... Being new to a professional practice is a challenging period of time. New nurses often report feelings of stress and anxiety, and medical errors may be made due to inexperience (Saintsing et al. 2011). Supporting new professionals during their first year seems to be key to strengthening self-confidence and reducing stress levels . ...
... Nurses are often in a continuous struggle to perform an increasing number of complex tasks under time-crunched conditions (Chan et al. 2013). Further complicating the nurse's job are the many decisions that must be made within that limited time (Saintsing et al. 2011). In a study of a medical admissions unit, it was found that a nurse confronts up to 50 important clinical decisions in a single 8-hour shift (Thompson et al. 2004). ...
... Thompson et al. (2008), for example, discovered that nurses in intensive therapy units encountered a clinical judgment or decision every 30 seconds. Along with that, in a study by Saintsing et al. (2011), nurses reported time constraints that limited their patient assessments with approximately 80% of the novice nurses acknowledging making mistakes due to time pressure. In this study, it was reported that each nurse made better decisions when there was no time pressure confronting their interactions. ...
Decision making by nurses is complicated by the stress, chaos, and challenging demands of the work. One of the major stressors confronting nurses is perceived time pressure. Given the potential negative outcomes on nurses due to perceived time pressures, it seems logical that a nurse manager's ability to lead nurses in moderating this time pressure and in turn to make better decisions could enhance nurse well-being and performance. Paralleling research in the nursing literature suggests that, in order to improve patients' judgement of the care they received, nurse managers should embrace ways to lower nurses' perceived time pressure. In this conceptual paper, we propose a model to help mitigate time pressure on nurse managers and their frontline nurses based on the research regarding time pressure, psychosocial care, time management, and self-leadership. Three metaconjectures and suggested future studies are given for further consideration by organizational and psychological researchers.
... To mitigate this novice-to-expert gap and foster CDM skills, novel pedagogies and various simulation technologies have been adopted into nursing education (Hoffman et al., 2004). However, multiple barriers still prohibit sufficient CDM, especially among novice nurses (Alowais et al., 2023;Fazlollahi et al., 2022;Saintsing et al., 2011). ...
Aim
This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision‐making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience.
Design
This is a cross‐sectional study.
Methods
Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March–April 2023. Clinical decision‐making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision‐making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI.
Results
Concerning aspects of clinical decision‐making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re‐evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27–41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity.
Conclusions
A generative AI tool demonstrated indecisiveness and a tendency towards over‐triage compared to human clinicians.
Impact
The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision‐making.
Reporting method
This study adhered to relevant EQUATOR guidelines for reporting observational studies.
Patient or public contribution
Patients were not directly involved in the conduct of this study.
... When I have 15 patients on a ward to take care of on a night shift, I barely have time to distribute the medications, leaving little time to care for patients" other needs." According to Saintsing et al. [3], nurses indicated that time limitations constrained their capacity to conduct thorough patient assessments. Around 80% of entry-level nurses acknowledged making errors due to time pressure. ...
Background. Nurses face significant challenges as they attempt to manage an increasing number of complex responsibilities within limited time frames. This article explores the factors contributing to time-wasting behaviors among nurses in Palestine and emphasizes the significance of effective time-management skills in nursing practice. Methods. Surveys were collected from a total of 714 nurses working in multiple healthcare facilities located in the north of the West Bank, Palestine. An 11-item time-wasting scale was developed and validated. Factors influencing time-wasting behaviors among nurses were then investigated using multiple linear regression in SPSS version 25. Results. Attending time management courses significantly reduced time-wasting behaviors. Additionally, factors such as age, gender, and educational level did not appear to correlate with time-wasting behaviors. However, workplace, type of organization, and attendance of time management courses did impact nurses’ time management skills. Conclusion. This article underscores the importance of time management skills in nursing practice. Inefficient time management can have detrimental effects on patient care and nursing outcomes. To mitigate these challenges, healthcare institutions and nursing education programs should prioritize time management training for nurses.
... Novice nurses need to be encouraged to set limits and speak up when faced with situations that could lead to errors. It is the institution's responsibility to provide an environment that supports transition into professional practice, promotes clinical decision making and personal and professional competency while reducing situations that lead to errors (Benner, 1984;Saintsing et al., 2011). All professional staff need to be involved with practice changes within their departments following the error, allowing for further professional growth while recovering from the error. ...
In this project we used sequential qualitative, QUAL → qual (i.e., sequential qualitative mixed method-method design) to explore the experiences of 36 nurses involving 44 clinical errors. With the core QUAL component, we used content analysis to describe the context and develop a new taxonomy—Circumstances-of-Error. This compensates for limitations in the presently used scale, TERCAP, developed in 2002. The revised scale links error types with error causation, thus enabling the institution to identify problems within its system as well as personnel. Next, in the sequential qual component, we linked each type of error with the emotional impact experience by nurses involved in the process. A constructivist grounded theory with the post-error stages—Impact of the Error, Losing Competency and Reestablishing Competency—describes the emotional ramifications of the experience. Three types of responses were prevalent, somatic, angst, and mortification, which shattered the confidence of staff resulting in nurses leaving or transferring from the unit. In addition to the cost to patient safety, estimating the cost of errors must also include cost to professionals, staff in general, the institution, and to the profession.
... In relation to frequent errors, the little experience and knowledge of novice nurses at the time of starting work, are the factors that increase the error in decision making and expose them to many errors in the field of clinical environments (Gillespie & Peterson, 2009). Nurses face conflicting challenges in choosing decisions, especially in critical situations, due to fear of errors and the possibility of making wrong decisions in clinical settings (Saintsing et al., 2011). ...
Introduction
The majority of newly graduated nurses are not prepared to work at the bedside; therefore, they may not have the appropriate self-confidence.
Objective(s)
The present qualitative study aimed to explain the novice nurses’ experience of weak professional confidence.
Design
This qualitative study was performed using a content analysis method.
Methods
Content analysis was utilized to identify themes from interview transcripts. They were included in the study by purposeful sampling. Participants were interviewed through face-to-face and unstructured interviews. All data were recorded, transcribed, and analyzed based on the Graneheim and Lundman method.
Results
Thirteen nurses participated in interviews. After data collection, all interviews were implemented and reviewed and the categories and subcategories were extracted. Three main categories containing turbulence in working life, unpleasant interactions, and lack of knowledge were extracted.
Conclusion
According to the study findings, most novice nurses experienced turbulence in their working life, unpleasant interactions, and a lack of knowledge that affected their self-confidence. Therefore, educational and support programs are suggested to improve novice nurses’ professional confidence.
Relevance to Clinical Practice
According to the results of the study, the lack of self-confidence in novice nurses reduces the quality of care. Therefore, taking into account the experiences of the participants, nursing education managers should plan in such a way as to improve the self-confidence of the graduates. In addition, novice nurses need to be supported by their managers and colleagues to develop their professional confidence to provide more effective care.
... 9) A particularly high number of incidents are caused by inexperienced nurses. 10) On the other hand, highly experienced nurses who have accumulated a wealth of knowledge play a central role in the prevention of incidents. 11) Nevertheless, even highly experienced nurses are sometimes responsible for incidents. ...
The aim of this study was to elucidate the differences in the causes of incidents at each stage of drug administration between nurses with different numbers of years of experience and current nursing unit tenure. We evaluated 510 reports involving medications taken after meals where medication charts were utilized. These reports were selected from 1,173 incident reports involving drug administration by hospital ward nurses in advanced treatment hospitals with 640 bed capacities in the northeastern area of Japan between fiscal 2012 and 2014. Approximately 40% of these were related to the drug preparation stage. There was no difference in the frequency of incidents between nurses with less than 2 years and those with 11 or more years of experience. As per the results of our correspondence analysis of the relation between the nursing unit tenure and the causal factors for each stage, "insufficient checking" at all stages was the most common factor. At the drug preparation and distribution stages, 11 or more years of experience were related to physical conditions. At all stages, nursing unit tenure of less than 2 years was related to psychological conditions. The findings indicated that nurse training and organized approach are required to minimize human factors involved in medical incidents. Hirosaki Med．J. 68：23-32，2017
... As a result, the Great Resignation shifted the predominant workforce characteristics towards younger and less experienced staff compared to the pre-pandemic workforce. Research suggests that novice nurses are more prone to make medical errors, impacting the quality of care provided to their patients and driving the healthcare community to search for innovative approaches in education and clinical practice [76]. Younger generations prefer collaboration over competition and mentorship relationships with their bosses over the standard hierarchical structures in healthcare organizations [77]. ...
The Intensive Care Unit (ICU) has evolved in the last 50 years. This evolution’s main drivers include equipment and software improvements, the patient safety movement, and a better pathophysiological understanding of critical illness. There is mounting pressure from accreditation agencies, governmental regulation, financial challenges, operational dynamics, staffing changes, and increased acuity affecting-ICU care delivery and impacting patient safety. There are higher than ever expectations to improve clinical outcomes after an intensive care stay, to enhance patient safety, to increase family involvement in decision making, and merge the multidisciplinary medical experience into an effective teamwork. Leadership focus is directed towards increasing diversity and inclusion in the workforce while enhancing psychological safety. This review addresses the common risks for patient safety in the intensive care setting and describes the changes in mindset and application of evidence-based mitigation strategies.
... En el modelo de transición de Shoessler y Waldo (2006), en la etapa ending que abarca los tres primeros meses de trabajo es donde la enfermera aprende a realizar tareas y procedimientos, el primer error es uno de los acontecimientos que marca a la enfermera en esta etapa como profesional. Observamos por tanto que coincidimos con estos autores en que el error es vivido de suma importancia para la nueva enfermera y sus discursos coinciden con el de los autores Saintsing et al, (2011). También coincidimos con dichos autores en la necesidad de la formación, en el apoyo a las enfermeras noveles para reducir sus tasas de error y así mejorar la seguridad del paciente. ...
Los significados que las enfermeras egresadas entre 2009 y 2014 de la Universidad de La Laguna atribuyen al desempeño de su puesto profesional tras su incorporación laboral en distintas instituciones sanitarias en la isla de Tenerife (España), se relacionan con un proceso de interacción con el contexto laboral donde la nueva enfermera siente y actúa dentro de ese contexto socializador. La incorporación laboral se ve influenciada además por las vivencias de la enfermera experimentada como estudiante a las que se suman las vivencias de la responsabilidad, de asimilar el nuevo rol profesional, de las faltas de preparación y de estabilidad profesional unidas a la complejidad del servicio en el que poder integrarse y sentirse o no apoyadas y el temor al error, caracterizan la vivencia a la incorporación laboral.
... A few possible explanations for these findings are presented here. First, younger nurses have less experience in dealing with different stressors and may have less mature problem-solving and decision-making skills (Saintsing, Gibson, & Pennington, 2011), which are vital when handling patient issues and caring for patients with complex nursing care needs such as COVID-19 patients. Second, younger nurses may lack confidence or self-efficacy, adaptive coping skills, and work experience (García-Martín et al., 2021) to adequately manage the numerous challenges posed by the pandemic. ...
Background
Nurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses’ CF in relation to job outcomes and care quality during the pandemic.
Aims
This study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses’ job outcomes (job satisfaction and turnover intention) and care quality.
Design
An online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.
Results
Overall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = -0.145, p = 0.019), lower job satisfaction (β = -0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = -0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = -0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).
Conclusion
Frontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses’ job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.
... Patient outcomes are also affected when NGNs are not prepared for practice (Hickerson et el., 2016). Smith and Crawford (2003) report that 49% of NGNs had been involved in a medical error, and primary types of errors involving NGNs include medication errors and errors that result in patient falls and delay of treatment (Saintsing, Gibson, & Pennington, 2011). ...
PURPOSE: The purpose of this research was to identify the value of undergraduate nursing student clinical preparation within a dedicated education unit on transition to practice. SPECIFIC AIMS: Describe perceived competence, practice readiness, self-efficacy, job satisfaction, intent-to-stay and orientation length of students who participated in a clinical experience in a dedicated education unit upon graduation, 3- and 6-months employment. Explore new graduate nurses’ perception of the impact of a dedicated education unit clinical experience on transition to practice. Examine relationships between outcome variables. Explore associations between outcome variables and demographic and employment characteristics. FRAMEWORK: This research was guided by Albert Bandura’s Social Learning Theory. DESIGN: This study used a descriptive, longitudinal design with quantitative measures and qualitative interviews. RESULTS: 18 participants provided quantitative data, and five participated in an interview. Competence, practice readiness and job satisfaction were relatively high. Self-efficacy remained essentially unchanged at all three time points. Average orientation length was 13 weeks, with 41.7% reporting their orientation was shorter than planned. At 6-months employment, 91.7% planned to stay in their current position for one year. Competence and Self-efficacy were associated at 3- and 6-months. Prior healthcare work experience was associated with higher competence at 3- and 6-months. Participants valued the experience of working with a preceptor and the supportive learning environment that allowed them to develop technical and professional nursing skills. CONCLUSION: These findings support dedicated education units as having a positive impact on new graduate nurse’s transition to practice.
... Vården är beroende av sjuksköterskans förmåga att känna igen och agera vid rätt tidpunkt (Massey, Chaboyer & Anderson 2017). När den nyutexaminerade sjuksköterskan genomför kliniska bedömningar finns risk för att viktig behandling fördröjs (Saintsing, Gibson & Pennington 2011). Orsaken är den nyutexaminerade sjuksköterskans bristande kliniska erfarenhet (Clipper & Cherry 2015;Ebright, Urden, Patterson & Chalko 2004;Purling & King 2012). ...
Under sjuksköterskeutbildningen ska studenten tillägna sig generella färdigheter som ger förutsättningarna för att vårda i en mängd olika miljöer. Ett område som beskrivits som särskilt problematiskt för den nyutexaminerade sjuksköterskan är att vårda i akuta situationer. Den här avhandlingen beskriver akuta situationer ur nyutexaminerade sjuksköterskors perspektiv och syftar till att beskriva och förklara den nyutexaminerade sjuksköterskans uppfattade förmåga att vårda i akuta situationer och vad som påverkar förmågan. Resultatet beskriver hur en nyutexaminerad uppfattar vårdsituationer som akuta när något händer plötsligt, när tiden inte räcker till, när kompetens är otillräcklig, när ansvaret blir överväldigande, när brister i omgivningen synliggörs och när mellanmänskliga relationer blir utmanande. Förmågan att vårda i akuta situationer påverkas av sjuksköterskeutbildningen, tillgång till stöd den första tiden som yrkesverksam, erfarenhetsbaserad kunskap och personlighetsdrag. Att vårda i akuta situationer kan på en sammanfattande nivå förstås utifrån begreppen kunskap, erfarenhet och tillit. För att förbättra förmågan att vårda i akuta situationer föreslås åtgärder för att öka erfarenheten av att vårda i akuta situationer
... According to the World Health Organization (2019), one in 300 hospitalized individuals die each year from health care errors. Because of underdeveloped clinical judgment skills, novice nurses, such as newly licensed registered nurses, are at greater risk for making these errors (Saintsing, Gibson, & Pennington, 2011). ...
Background
The use of written or computer-based examinations to assess readiness to for entry into professional nursing practice assumes a relationship between cognitive assessment and clinical nursing judgment, but there is no evidence to support this.
Methods
This quantitative, correlational study used historical data from a school of nursing database to conduct a retrospective analysis to examine the relationships between NCLEX-RN® predictor exams, clinical reasoning, clinical nursing judgment, and simulation performance at the end of a baccalaureate nursing program.
Results
The results did not show a positive relationship between critical thinking and clinical reasoning, clinical nursing judgment or simulation performance.
Conclusions
Consistent with other studies, the lack of a relationship demonstrates that readiness to take and pass the NCLEX-RN® is not adequate for evaluation of readiness for entry into professional nursing practice.
... Differences in environments from school to work also created problems for many of the cases they reviewed. Conversely, research also suggests that novice workers are prone to struggle with overwhelming emotions around the volume of new material they must acquire [81,82] and may compensate by working longer hours and exposing themselves to ill health [83]. Previous studies suggest that these risk factors can be at least partially ameliorated through the higher adaptability skills that the present intervention seems to promote and develop [84,85]. ...
Background:
As emotional and social competency training proliferates within a work readiness context, concerns remain regarding their efficacy. Data on these programs tends to be scarce and outcome objectives are often poorly defined.
Objective:
Authors developed and tested a work readiness emotional and social competency program specifically designed for at-risk young adults, tailored with best practices in mind.
Method:
84 clients of a community organization that provides employment support to young adults with disabilities (48 men and 36 women) with a mean age of 28.17 years (SD = 11.64) completed measures of emotional intelligence and alexithymia on either side of the 4-week intervention.
Results:
Men's interpersonal scores and women's adaptability scores showed significant improvement across the intervention. In addition, women's scores in both identifying and describing feelings improved significantly, as did men's scores in describing feelings.
Conclusions:
Within the context of work readiness, participants in an intervention to improve emotional and social competencies can see key improvements to competencies linked to occupational attainment.
... Previous researchers have argued that novices possess fewer years of experience and clinical attentiveness and therefore may be prone to be less mindful. 35,58 Aligned with this argument, a study conducted by Martins et al 59 demonstrated that patients who were treated by novice nurses seemed to report less satisfaction. Compared with novice nurses, experienced nurses may have better mindfulness competence, which is acquired by developing a heightened sense of awareness. ...
Purpose. To examine the effect of a novel mindfulness-based timeout intervention (MBTI) on state mindfulness among Emergency nurses and accordingly on patient satisfaction.
Method. A pre-post intervention design among nurses in the ED with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the ED of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the ED was recruited (n=1920 patients, 960 in each phase). The MBTI was based on the theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses’ sociodemographic and professional characteristics and trait mindfulness were collected pre intervention. Pre and post intervention, we collected data on patients’ sociodemographics and satisfaction, nurses state mindfulness and ED workload.
Results. We found an increase in nurses’ state mindfulness and patients' satisfaction in post compared to pre MBTI (4.35±0.64 vs. 4.03±0.82, p<.001; 4.03±0.41 vs. 3.16±0.44, p<.001; respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r=0.287, p<.001). The findings also demonstrated that state mindfulness was higher among nurses characterized by high trait mindfulness, post MBTI implementation.
Conclusion. By adapting mindfulness principles to the dynamic environment of the ED, we showed that the MBTI was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.
... In the present study, NGRNs reported a lack of medical competence in judging prescriptions, a fear of making mistakes and actually making mistakes. Medication errors are related to complex patient situations (Saintsing, Gibson, & Pennington, 2011), and NGRNs need further training to better understand the interactions between medications, side effects and the effect of medications on patients' ...
Aim:
To explore newly graduated registered nurses' experiences and how they manage complex patient situations.
Background:
Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, co-morbidities, and staffing shortages.
Design:
Qualitative study design.
Methods:
Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of six months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.
Results:
The analysis resulted in the overarching theme `Not being sufficiently prepared and supported to meet responsibilities and demands´. The theme included three categories: `Responsibility is not in proportion to competence´, ` Lack of medical competence and experience complicates patient safety´, and `Strives for control to manage and organize nursing care´.
Conclusion:
The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.
... Research has shown that 54% of medical errors including errors in the emergency-care process is due to nurses [18,19]. Novice nurses, lacking clinical experience and critical-thinking skills, are especially error-prone [20]. To prevent such medical errors in a clinical setting, the most effective strategy is to incorporate situational, scenario-driven training exercises into nursing education and professional training. ...
Objective:
The study intended to combine team-oriented, problem-based learning (PBL) with emergency-care simulation to investigate whether an integrative intervention could positively impact the core nursing competencies and teacher performance of nursing students.
Methods:
The study belonged to the domain of action research, which aimed to address the weaknesses of traditional teacher-led, lecture-based learning. An 18-week, single-case experimental design, in which 58 senior nursing students at a medical university in central Taiwan participated, was conducted to test the possible benefits of the intervention. The measures included the Scale of Core Nursing Competencies and the Teacher Performance Evaluation Scale.
Results:
The research results showed that nursing students who received integrative training that combined team-based PBL with emergency-care scenario simulation had stronger mastery over core nursing competencies. At the same time, they also evaluated both the "Emergency Care" course for which the curriculum was used and the teachers' performance in that course more highly.
Conclusions:
The findings suggest that an integrative curriculum combining team-based PBL with scenario simulation is worth pursuing. Compared with traditional teacher-led, lecture-based teaching, this curriculum may be more effective in helping nursing students develop core competencies in their field.
... 9) A particularly high number of incidents are caused by inexperienced nurses. 10) On the other hand, highly experienced nurses who have accumulated a wealth of knowledge play a central role in the prevention of incidents. 11) Nevertheless, even highly experienced nurses are sometimes responsible for incidents. ...
... In addition, as it has been documented that nursing students and new graduate nurses with less than a year of clinical experience are involved in 49%-53% of patient falls, medication administration errors and failure-to-rescue incidents simulation training can prevent these situations (Saintsing et al., 2011;Beroz and Hallmark, 2017;Kenward and Zhong, 2006). Repetitive supervised practice with critique and feedback from faculty embedded into virtual reality simulator helps students to become more competent in clinical skills and enhance their performance (Oermann et al., 2011;Chiniara et al., 2013). ...
... In addition, as it has been documented that nursing students and new graduate nurses with less than a year of clinical experience are involved in 49%-53% of patient falls, medication administration errors and failure-to-rescue incidents simulation training can prevent these situations (Saintsing et al., 2011;Beroz and Hallmark, 2017;Kenward and Zhong, 2006). Repetitive supervised practice with critique and feedback from faculty embedded into virtual reality simulator helps students to become more competent in clinical skills and enhance their performance (Oermann et al., 2011;Chiniara et al., 2013). ...
... Among NGRNs, medication errors are related to nursing care with heavy patient workloads and patients with complex medical diagnoses (Saintsing, Gibson, & Pennington, 2011). It is therefore timely to take this seriously to avoid the consequences of medication errors and to ensure that they do not develop further. ...
Aim:
To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.
Background:
NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context and professional nurses' clinical competence is critical in providing high quality and safe nursing care.
Design:
A cross-sectional design.
Methods:
Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines was used.
Results:
The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.
Conclusion:
The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programs for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves as well as patient safety.
Relevance to clinical practice:
An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organizing nursing programs and in making clinical policy decisions when designing introduction programs in acute care settings.
... He identified both individual (age, educational level, experience, knowledge cue recognition, hypothesis updating, communication, emotions, and perceptions) and environmental factors (task complexity, time pressure, interruptions, area of specialty, and professional autonomy) that impact clinical decision-making. Saintsing, Gibson and Pennington (2011) conducted an integrative review and found that the primary types of errors committed by novice nurses were related to giving medication, patient falls, and delays in treatment. Further, Berkow, Virkstis, Stewart and Conway (2009) surveyed over 5,000 frontline nurses and asked them to rate their satisfaction with novice nurses' proficiency in 36 different competencies. ...
In the near future, the National Council of State Boards of Nursing (NCSBN) plans to implement the Next Generation National Council Licensure Examination (NCLEX) (NGN) project to improve the measurement of clinical judgment in new graduates. Primarily, faculty will need to prepare students for an additional type of testing. The purpose of this article is to demonstrate an approach for constructing questions that simulate the NGN prototypes.
... Over half (61%) of all registered nurses (RNs) in the United States work in general medical-surgical acute care hospitals (U.S. Bureau of Labor Statistics, 2018), and the literature reports that 50% of newly licensed RNs are involved in patient safety events, which are defined as errors in patient care that may or may not result in an adverse outcome for the patient (Kim, Kim, & Kang, 2016). New RNs are more likely than experienced RNs to be involved in patient safety events, especially those who work the night shift (Kim et al., 2016;Saintsing, Gibson, & Pennington, 2011). While many RN training programs utilize simulation-based training in combination with other training methodologies to improve clinical competence (Smiley et al., 2018) , limited evidence exists about the relationship between simulations in adult acute care training and their connection to actual patient safety outcomes. ...
Background:
Simulation is increasingly used as a training tool for acute care medical-surgical nurses to improve patient safety outcomes. A synthesis of the evidence is needed to describe the characteristics of research studies about acute care nurse simulation trainings and patient safety. An additional purpose is to examine the effects of acute care registered nurse (RN) simulation trainings on patient safety outcomes.
Methods:
Five Internet databases were searched for articles published on any date through October 2018 examining the effect of RN simulation trainings on patient safety outcomes in the adult acute care setting.
Sample:
N = 12 articles represented 844 RNs of varying experience levels and 271 interprofessional participants.
Results:
Nine studies (75%) used high-fidelity scenarios developed locally about high risk but infrequent events. Five studies (42%) incorporated interdisciplinary team members in the scenarios and/or outcome evaluations. Outcome measures were self-reported, direct observation, or clinical indicators. All studies in this review achieved improved patient safety outcomes. It is unknown how outcomes vary for different groups of RNs because of insufficient gender, ethnicity/race, and age reporting.
Linking evidence to action:
Findings support the design of simulation training research studies for patient safety outcomes and use of simulation training and research in acute care RNs. Additional high-quality research is needed to support this field. Future studies should include descriptors that characterize the sample (i.e., age, gender, education level, type of nursing degree, ethnicity or race, or years of experience); incorporate interdisciplinary teams; evaluate a combination of outcome measure types (i.e., self-report, direct observation, and clinical outcomes) both proximal and distal to the simulation; and that utilize standardized scenarios, validated outcome measure instruments, and standardized debriefing tools.
Background
Despite the efforts of academic nursing educators to prepare students to make sound clinical judgments, the literature suggests new graduate nurse (NGN) competence with this critical skill continues to decline. This study sought to identify how practicing nurses describe their observations of the use and outcomes of clinical judgment by NGNs in nursing practice.
Method
A multisite, cross-sectional survey using multiple-choice, Likert scale, and open response items to identify participants' observations of NGN clinical judgment was sent with snowball sampling and resulted in a sample of 314 participants from 19 U.S. states.
Results
Practice partners identified a wide discrepancy between how they expect NGNs to use clinical judgment and what they actually see NGNs do, with resultant negative effects on patients and NGNs.
Conclusion
These results provide a beginning understanding of NGNs' specific challenges with clinical judgment. Efforts to improve clinical judgment across nursing education and practice are needed. [ J Contin Educ Nurs. 202x;5x(x):xx–xx.]
Aims and Objective
To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care.
Background
Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence.
Design
Descriptive and correlational design.
Methods
The study was conducted among newly graduated nurses ( n = 201) working in acute care hospitals for 1–12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist.
Results
The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care.
Conclusions
Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses.
Relevance to Clinical Practice
The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.
Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code–assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.
The aim of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice. Medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. To better understand nursing workflow and documentation workload in today's clinical environment, it is important to understand patterns of medication administration and alert generation during barcode-assisted medication administration. Study objectives were addressed through a descriptive, longitudinal, observational cohort design using secondary data analysis. Set in a large, urban medical center in the United States, the study sample included 132 new graduate nurses who worked on adult, inpatient units and administered medication using barcode-assisted medication administration. Data were collected through electronic health record and administration sources. New graduate nurses in the sample experienced a total of 587 879 alert and medication administration encounters, administering 772 unique medications to 17 388 unique patients. Nurses experienced an average medication workload of 28.09 medications per shift, 3.98% of which were associated with alerts, over their first year of practice. In addition to high volume of medication administration, new graduate nurses administer many different types of medications and are exposed to numerous alerts while using barcode-assisted medication administration.
Introduction: The aim of this study was to investigate the effect of cultural capital dimensions on occupational error and professional ethics of nurses with emphasis on their biological experience. Methods: The present research method is correlational and applied and the statistical population of the research is nurses working in two hospitals (Ghaem and Razavi) in Mashhad, the number of which is 580 people, of which 230 people were selected as a random sample. Two standard questionnaires (professional ethics and cultural capital) were used to collect data. the reliability of the questionnaires with Cronbach's alpha higher than 0.860 was evaluated as optimal and the data were analyzed using SPSS and smartpls2 statistical software. The theoretical approach of the research was also a combination of theories. Results: According to the results, cultural capital did not show a significant relationship with the professional ethics of nurses. The coefficient of determination R2 for the dependent variable shows, also the value of 0.617 obtained from the overall fit of the GOF criterion indicates that the utility model has a high level. Conclusions: Therefore, based on the results, it can be said that in order to improve the level of professional ethics in nurses, special attention should be paid to the component of cultural capital.
Background:
Simulation-based learning is a teaching technique that allows learners to apply theoretical knowledge to enhance patient safety. Despite limited evidence about the relationship between simulation and patient safety outcomes, nursing programs continue using simulation to improve student competencies.
Purpose:
To explore the processes driving the actions of nursing students while providing care for a rapidly deteriorating patient during a simulation-based experience.
Method:
Following the constructivist grounded theory method, the study recruited 32 undergraduate nursing students to explore their experiences during simulation-based experiences. Data were collected using semi-structured interviews over 12 months. Interviews were recorded, transcribed and analyzed using constant comparison and simultaneous data collection, coding, and analysis.
Results:
Two theoretical categories emerged from the data to explain the processes driving the students' actions during simulation-based experiences: Nurturing and contextualizing safety. The themes revolved around a core category of "Scaffolding Safety" in simulation.
Conclusion:
Simulation facilitators can use the findings to build effective and targeted simulation scenarios. Scaffolding safety steers students' thinking and contextualizes patients' safety. It can be utilized as a lens to guide students and assist them with transferring skills from simulation to the clinical practice setting. Nurse educators should consider deliberately integrating the concepts of scaffolding safety into simulation-based experiences to connect theory and practice.
Background:
Nurses play a vital role in the medication administration process and are frequently involved in adverse drug events (ADEs). One identified cause of ADEs is lack of pharmacology knowledge received during their training and/or failure to maintain this core information: the latter cause has been described as skill decay.
Purpose:
The purpose of this quality improvement project was to implement an online pharmacology review program to maintain and/or improve nursing students' pharmacology knowledge, thus decreasing skill decay over the school's summer break.
Methods:
Nursing students enrolled in a 4-year BSN program participated in a virtual pharmacology knowledge review program consisting of a pretest survey, learning modules, quizzes, and a final posttest survey.
Results:
Comparisons showed statistical significance in test score improvement from pretest to posttest.
Conclusions:
This project demonstrates that a review program can enhance nursing students' pharmacology knowledge throughout their summer break. It adds to the limited data about the need for pharmacology programs to decrease skill decay.
Aim:
This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment.
Background:
Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used.
Method:
A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models.
Results:
Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation.
Conclusion:
Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.
Resumen
este artículo analiza el papel del entrenamiento con simulación para formar a las enfermeras y reducir los errores clínicos, y describe un proyecto de investigación elaborado para establecer la efectividad de la práctica consciente y la tecnología de simulación.
While the transport and retrieval of critically ill children has been extensively researched and audited, nurse-led repatriation and retrieval of non-critical children and neonates has only recently become a full-time nursing position in Northern Ireland. In January 2020, the Northern Ireland Specialist Transport and Retrieval (NISTAR) service developed a nurse-led transport team for this patient population and created a new role - the non-critical paediatric transport nurse - which incorporates the skills of a children's nurse. The aim of the service is to transport children and neonates safely between the regional paediatric unit and local district general hospital paediatric wards in Northern Ireland. The nurse-led service also transfers children with non-critical complex cardiac conditions between paediatric wards in Northern Ireland and the national centre for paediatric cardiology and cardiothoracic surgery in Dublin, Ireland. This article describes the role of the nurse-led transport team and discusses clinical governance, training requirements and the safe transfer of children with complex cardiac conditions. The NISTAR team won the child health category at the 2021 RCN Nursing Awards.
The COVID-19 pandemic has impacted traditional pathways for new graduate registered nurses (NGRN's) transition to practice. In response to stay at home emergency orders in 2020, NGRN's experienced changes in pre-licensure curriculum, clinical practicums, NCLEX testing, and licensure, all which influence preparedness for professional practice. The adverse impact on education and clinical training extends to all nursing students who attended higher education institutions of learning during 2020 to present and is a significant consideration with new graduates over the long-term, whom will be caring for patients in healthcare settings. Well before this pandemic, literature identified that NGRN's were predisposed to knowledge-practice gaps and lacked situational awareness. Recent nursing research emerging from the pandemic reveals a potentiating negative impact of the abbreviated pre-licensure experiences on patient safety in the clinical setting. In the current healthcare environment, it is preemptive for healthcare institutions and schools of nursing to work cohesively to ensure patient safety through an increased emphasis on evidence-based approaches to reduce patient harm and mitigate harm when it does occur. Further, in response to the increased demand for nurses by healthcare organizations, considerations for safety, risk management, and ethical care must be considered during the transition to practice for NGRN's.
Although the understanding of clinical reasoning and judgment in nursing has advanced during the past 2 decades, widespread improvement in clinical judgment remains elusive. Every nurse—including direct caregivers, administrators and educators, and leaders in regulatory positions—should embrace a shared understanding of clinical judgment, its implications for patient safety, and the roles of education, practice, and regulation for improving the ongoing deficit in this skill. This article provides an update on the state of the science of clinical reasoning and judgment in nursing, describes the influence of clinical judgment on patient safety, and identifies the academic, practice, and regulatory implications for promoting sound clinical judgment in new graduate and existing nurses.
Novice nurses category will experience fear, panic, not ready and doubts to interact with patients, families of patients and other more senior nurses. This study aims to describe or explore the burden experience and source of support for novice nurse . The study used a descriptive phenomenology design involving seven participants who were nurse nurses at the emergency department. Data analysis using Braun and Clark thematic analysis. The four themes produced in the study illustrate the experience of novice nurses facing patient with emergent condition in emergency department. Required guidance and mentoring process for novice nurses at the beginning of the working period at the emergency department Keywords: novice nurses , emergency patients
Background: In Asian countries, clinical practice places little emphasis on developing the clinical decision-making skills and social problem-solving abilities of nursing students.
Objective: This study explored whether a 3-months-in-1-unit training program improved nursing students' clinical decision-making skills and social problem-solving abilities compared to the 1-month-in-1-unit rotation program.
Methods: A quasi-experimental study was conducted. A 3-months-in-1-unit training program was conducted in the intervention group (n = 77), rountine1-month-in-1-unit rotation was conducted in the control group (n = 73). Clinical decision-making skills and problem-solving abilities were measured using the Chinese version of the Clinical Decision-Making Nursing Scale and the Social Problem-Solving Inventory–Revised.
Results: Nursing students in the intervention group scored higher clinical decision-making skills (t = 7.677, p < 0.05), positive problem orientation (t = 18.359, p < 0.05), negative problem orientation (t = −3.711, p < 0.05), and rational problem-solving (t = 2.312, p < 0.05) than the control group.
Conclusions: The 3-months-in-1-unit specialized training program had a significant positive impact on students’ clinical decision-making skills and social problem-solving abilities.
Purpose: The purpose of this study was to identify effects of Handoff Education using Concept mapping and PASS-BAR (HECPAR) on clinical reasoning competence, self-efficacy for handoff, and handoff performance of new nurses.Methods: Participants were randomly allocated into an experimental group (n=20) and control group (n=21). The experimental group received HECPAR which consisted of a one hour lecture, case based clinical practicum, and mentoring for a week. The control group received the usual informal handoffs education from senior nurses. Clinical reasoning competence, self-efficacy for handoff, and handoff performance were measured before and a week after HECPAR. Data were analyzed using Mann-Whitney U test, independent t-test, Fisher’s exact test, and chi-sqaure test. Results: The experimental group showed significant improvement in clinical reasoning competence (z=-2.29, p=.022), handoff performance (z=-2.23, p=.026), and self-efficacy of handoff (t=3.47, p=.001) compared to the control group.Conclusion: The results indicate that HECPAR is effective in improving clinical reasoning competence, self-efficacy for handoff, and handoff performance by new nurses. In addition, integrating concept mapping, PASS-BAR, and mentoring proved beneficial for handoff education for new nurses.
Background
Bioscience in nursing education covers a broad range of disciplinary areas (anatomy, physiology, pathophysiology and pharmacology) and underpins clinical assessment and critical thinking in nursing practice. This is imperative for patient safety and favourable patient outcomes. In nursing programs for registration, most bioscience content is taught during the early phases of the program and little incorporated into postgraduate nursing programs.
Objectives
The aim of this study was to explore student’s perceived relationship between clinical relevance and engagement (attention and time) with bioscience content, by surveying undergraduates and postgraduate nursing students.
Design
This sequential mixed methods study included two phases.
Methods
The first phase comprised of focus group interviews from one Australian University. Thematic analysis of these data, coupled with existing literature, informed the second study phase; a quantitative questionnaire.
Participants
Focus group interviews included N= 30 students from one tertiary site; 10 from each year level. The questionnaire was administered to nursing students undertaking undergraduate nursing studies (1st,2nd & 3rd years), and postgraduate nursing studies.
Results
Nursing students (n=406) across three Australian universities (four programmes) completed the questionnaire. The clinical relevance of bioscience was widely appreciated; 91.6% of undergraduate nursing students and 98.5% of postgraduate nursing students indicated that every nurse must have a good understanding of bioscience. However, there was an inverse relationship between engagement with bioscience and timing in the curriculum, as 50% of undergraduate nursing students indicated that bioscience content took up too much of their time, compared to only 20% of postgraduate nurses (odds ratio 0.27 [0.16–0.46], p<0.001).
Conclusion
Nursing students’ perceptions of the clinical relevance of bioscience for their career strongly corresponds with their progression through their studies. Unfortunately, as students progress to the later years of their nursing education, their engagement with formal bioscience education decreases. This poses the question ‘Are we delivering bioscience content to nursing students at the appropriate time?’.
Background
Deliberate inclusion of clinical decision-making nursing skills in the didactic setting will assist students in potentially making better patient care decisions. This can be optimized through use of the flipped learning andragogy. Flipped learning promotes an interactive classroom environment. It fosters teamwork and collaboration. Direct content instruction is the responsibility of students.
Objective
This cohort pilot study investigated how the flipped and nonflipped approach to teaching impacted clinical decision-making and student participation.
Methods
The Clinical Decision-Making in Nursing Scale (CDMNS) was administered to the students in the flipped classroom and the nonflipped classroom on week 1 and week 6. A student participation checklist was used to observe class activities at three separate intervals (baseline, mid-semester, and end-semester). A repeated measures analysis of covariance was conducted with Instruction Group as the between subjects factor (Flipped and Nonflipped) and Time (preinstruction and postinstruction) as the within subjects factor, and covarying age. The Time by the Instruction group was significant. The Flipped group showed an increase in Clinical decision-making scores ( p < .001) after instruction while the Nonflipped group did not ( p = .40).
Results
The Flipped group ( n = 24) showed an increase in Clinical decision-making scores ( p < .001) after instruction while the Nonflipped group ( n = 23) did not ( p = .40). The Flipped classroom showed 100% participation at baseline, mid-semester, and end of semester. The Nonflipped classroom showed overall lower levels of participation, with 42%, 33%, and 39% at each point respectively.
Conclusion/Implications for Nursing
Students who were taught using the flipped instruction were able to apply what they learned in relevant case studies, virtual simulations, and practice National Council Licensure Examination RN (NCLEX-RN) type questions. Through teamwork and collaboration, students had time to practice clinical decision-making skills. This was evident in the increased CDMNS scores and increased levels of participation over time in the flipped group when compared to the nonflipped group.
Background
Beginning their post-licensure clinical practice can be a challenging time for new registered nurses. Pain management is considered an essential responsibility for nurses, requiring pain management that is prompt, safe and effective. Research is needed to examine the experiences of new registered nurses as they adjust to their new role using what they have already learned about pain and pain management.
Purpose
To examine the lived experiences of new registered nurses, who have been in the role less than a year, as they transition into their registered nurse role as a manager of pain utilizing what they have learned about pain and pain management in the undergraduate program and/or continuing professional development.
Design
This research was a phenomenological study in which interviews were audio-recorded and transcribed verbatim.
Participants/Setting
Eight new graduate registered nurses employed less than a year at a 415-bed regional hospital were interviewed.
Methods
Content analysis guidelines were used for the analyses of texts.
Results
Themes of navigating relationships, the practice of pain management and disconnect between school and real life were developed from the analyses of texts.
Conclusions
Knowledge generated from this study can be used to better understand the experience of new graduate registered nurses regarding pain management and enhance pain management curricula in undergraduate nursing education and continuing professional development.
Abstract
Game-based learning has attracted much attention in education in recent years due to its ability to increase student motivation and engagement in learning. This study reviewed the literature to answer the research questions: What learning outcomes have been linked to games in nursing education? What are potential gaps in the field's knowledge regarding games in nursing education?
Method:
A systematic literature search was completed in CINAHL and Google Scholar from 2009–2019 with the keywords of games, gaming, and nursing education.
Results:
A total of 49 papers were identified; of these, 34 were excluded, and 15 empirical studies were evaluated. The majority reported beneficial learning outcomes, such as increased knowledge, higher test scores, and positive student comments. Several methodological weaknesses were noted, such as small sample sizes, convenience samples, and lack of control groups or randomization.
Conclusion:
Games have the potential to prepare new nurses for improved clinical decision making. More robust research methodologies are needed to confirm best practices for educators.
Aim
The aim of this descriptive study is to determine the relationship between competencies and attitudes of nurses in medical errors.
Background
The level of competence of nurses directly affects the patient's safety, health status, morbidity and mortality rates, and satisfaction with nursing care. Nurses are expected to demonstrate a high level of competence in fulfilling their duties and responsibilities and thus to minimize the incidence of medical errors.
Methods
This study was carried out with nurses (n = 243) working in a university hospital in Turkey between May and July 2019. Personal information form, the Nurse Competence Scale and the Medical Errors Attitude Scale were used in the collection of data.
Results
A relationship was found between the competence of nurses and their attitudes in medical errors. It appeared that the work role subscale had the highest mean score (48.76 ± 6.83) according to the mean score for the nurse competence scale subscales. The mean scores of the diagnostic functions and ensuring quality subscales of the scale were found to be low. While the mean scores of the medical errors attitude scale of the nurses were close to each other, the highest mean score was found in the subscale of approach to medical errors (3.94 ± 0.35).
Conclusion
It was determined that the nurses had a moderate level of competence and that their attitudes towards medical errors were positive.
Implications for Nursing Management
It is necessary that the competence of nurses should be increased. Increasing their competence will also increase their awareness on medical error attitudes.
Background:
There is a growing concern that novice nurses who achieve licensure do not have the clinical judgment to practice safely. The National Council of State Boards of Nursing (NCSBN) began the Next Generation NCLEX (NGN) project to find methods to better assess entry-level competency. The NGN project is based on an integrative clinical judgment model (CJM) with 6 well-defined cognitive steps.
Problem:
Teaching and assessing clinical judgment skills using the NCSBN-CJM will take faculty planning and commitment.
Approach:
Clinical scenarios can be used to teach clinical judgment. Using prompts, instructors can deliberately lead students through the steps of recognizing cues, analyzing cues, prioritizing hypothesis, generating solutions, taking action, and evaluating outcomes.
Conclusion:
Committing to integrating a CJM throughout the curriculum, using realistic clinical scenarios, and having students work through all the steps of a selected model are important ways educators can help students prepare for safe clinical practice.
Medical education is founded on the understanding of physiology. While lecture materials and reading contribute to the learning of physiology, the richness and complexity of the subject suggest that more active learning methods may provide a richer introduction to the science as it applies to the practice of medicine. Simulation has been previously used in basic science to better understand the interaction of physiological systems. In the current context, simulation generally refers to interactive case studies performed with a manikin or anatomic device. More recently, simulation has grown to encompass computational simulation: virtual models of physiology and pathophysiology where students can see in a mechanistic setting how tissues and organs interact with one another to respond to changes in their environment. In this manuscript, we discuss how simulation fits into the overall history of medical education, and detail two computational simulation products designed for medical education. The first of these is an acute simulator, JustPhysiology, which reduces the scope of a large model, HumMod, down to a more focused interface. The second is Sycamore, an electronic health record-delivered, real time simulator of patients designed to teach chronic patient care to students. These products represent a new type of tool for medical and allied health students to encourage active learning and integration of basic science knowledge into clinical situations.
Medication errors continue to be a significant issue, posing substantial threats to the safety and well-being of patients. Through Bandura’s theory of self-efficacy, nursing students’ self-efficacy (confidence) related to medication administration was examined to investigate its influence on the generation of medication errors with the use of an Electronic Medication Administration Record (eMAR) in clinical simulation. This study examined the generation of medication errors and the differences that may exist based on nursing students’ perceived confidence. The findings of this study demonstrated that nursing students continue to generate medication errors within clinical simulation. No differences in the generation of medication errors were found between nursing students with perceived high levels of confidence and those with perceived low levels of confidence (one exception noted). Further examination of the variables and contextual factors related to safe medication administration practices is required to inform nursing education and practice.
The nature of novice nurses' clinical decision-making has been well documented as linear, based on limited knowledge and experience in the profession, and frequently focused on single tasks or problems. Theorists suggest that, with sufficient experience in the clinical setting, novice nurses will move from reliance on abstract principles to the application of concrete experience and to view a clinical situation within its context and as a whole. In the current health care environment, novice nurses frequently work with few clinical supports and mentors while facing complex patient situations that demand skilled decision-making. The Situated Clinical Decision-Making Framework is presented for use by educators and novice nurses to support development of clinical decision-making. It provides novice nurses with a tool that a) assists them in making decisions; b) can be used to guide retrospective reflection on decision-making processes and outcomes; c) socializes them to an understanding of the nature of decision-making in nursing; and d) fosters the development of their knowledge, skill, and confidence as nurses. This article provides an overview of the framework, including its theoretical foundations and a schematic representation of its components. A case exemplar illustrates one application of the framework in assisting novice nurses in developing their decision-making skills. Future directions regarding the use and study of this framework in nursing education are considered.
Registered nurse (RN) employment has increased during the current recession, and we may soon see an end to the decade-long nurse shortage. This would give hospitals welcome relief and an opportunity to strengthen the nurse workforce by addressing issues associated with an increasingly older and foreign-born workforce. The recent increase in employment is also improving projections of the future supply of RNs, yet large shortages are still expected in the next decade. Until nursing education capacity is increased, future imbalances in the nurse labor market will be unavoidable.
The average age of registered nurses (RNs), the largest group of health care professionals in the United States, increased substantially from 1983 to 1998. No empirically based analysis of the causes and implications of this aging workforce exists.
To identify and assess key sources of changes in the age distribution and total supply of RNs and to project the future age distribution and total RN workforce up to the year 2020.
Retrospective cohort analysis of employment trends of recent RN cohorts over their lifetimes based on US Bureau of the Census Current Population Surveys between 1973 and 1998. Recent workforce trends were used to forecast long-term age and employment of RNs.
Employed RNs aged 23 to 64 years (N = 60,386).
Annual full-time equivalent employment of RNs in total and by single year of age.
The average age of working RNs increased by 4.5 years between 1983 and 1998. The number of full-time equivalent RNs observed in recent cohorts has been approximately 35% lower than that observed at similar ages for cohorts that entered the labor market 20 years earlier. Over the next 2 decades, this trend will lead to a further aging of the RN workforce because the largest cohorts of RNs will be between age 50 and 69 years. Within the next 10 years, the average age of RNs is forecast to be 45.4 years, an increase of 3.5 years over the current age, with more than 40% of the RN workforce expected to be older than 50 years. The total number of full-time equivalent RNs per capita is forecast to peak around the year 2007 and decline steadily thereafter as the largest cohorts of RNs retire. By the year 2020, the RN workforce is forecast to be roughly the same size as it is today, declining nearly 20% below projected RN workforce requirements.
The primary factor that has led to the aging of the RN workforce appears to be the decline in younger women choosing nursing as a career during the last 2 decades. Unless this trend is reversed, the RN workforce will continue to age, and eventually shrink, and will not meet projected long-term workforce requirements. JAMA. 2000.
Graduate nurses experience stress transitioning from student to practicing professional nurse, moving from a familiar educational environment into the workforce, where expectations are to rapidly function as a competent nurse. This study identified the stresses and challenges experienced by cohorts of graduate nurses working in 6 acute care hospitals, during specific timed data periods, to better understand factors that may influence graduate nurse retention. Results report graduate nurses do not feel skilled, comfortable, and confident for as long as 1 year after being hired, highlighting the need for healthcare organizations to provide extended orientation and support programs to facilitate successful entry into practice.
The study purpose was to identify human performance factors that characterized novice nurse near-miss/adverse-event situations in acute-care settings.
Increased focus on recruitment and retention of newly graduated registered nurses (RNs) in light of patient safety improvement goals will challenge healthcare educators and administrators. What we are beginning to learn about human performance issues during real work situations from patient safety research provides information related to human performance in complex environments that may guide education and system supports for novice RNs.
Data collected during 8 retrospective interviews of novice RNs about details surrounding their individual near-miss or adverse event were analyzed for common themes.
Nine themes were identified. Seven themes were present in at least 7 of the 8 cases and included environmental and social issues, as well as novice lack of expertise.
Findings suggest that support for novice nurses in acute care environments requires attention to the following: consistent availability of expertise in light of workload unpredictability, the social climate regarding expectations of novice performers, realistic expectations of novice decision-making ability during complex situations even up to a year after graduation, and strategies to recognize and intervene when novices are at risk for error.
In this final article of an important four-part series the authors summarize their earlier findings and offer some potential strategies for dealing with an expected large decrease in the supply of RNs and continued aging of the RN workforce. Suggested actions to strengthen the professional nursing workforce include: Prepare for the needs of an older RN workforce - 40% of working RNs will be over the age of 50 by 2010. Develop ways to better use scarce RNs by enhancing the application of labor-saving technology and improve the training and competence of unlicensed assistive personnel. Rethink regulations mandating hospital staffing levels and ratios - shift focus to actively monitoring hospitals that cut nurse staffing excessively and make that information publicly available. Prepare for smaller RN student enrollments and modify the curriculum in response to realistic learning needs of students and ongoing changes in workplace demands.
Context The average age of registered nurses (RNs), the largest group of health
care professionals in the United States, increased substantially from 1983
to 1998. No empirically based analysis of the causes and implications of this
aging workforce exists.
Objectives To identify and assess key sources of changes in the age distribution
and total supply of RNs and to project the future age distribution and total
RN workforce up to the year 2020.
Design and Setting Retrospective cohort analysis of employment trends of recent RN cohorts
over their lifetimes based on US Bureau of the Census Current Population Surveys
between 1973 and 1998. Recent workforce trends were used to forecast long-term
age and employment of RNs.
Participants Employed RNs aged 23 to 64 years (N = 60,386).
Main Outcome Measures Annual full-time equivalent employment of RNs in total and by single
year of age.
Results The average age of working RNs increased by 4.5 years between 1983 and
1998. The number of full-time equivalent RNs observed in recent cohorts has
been approximately 35% lower than that observed at similar ages for cohorts
that entered the labor market 20 years earlier. Over the next 2 decades, this
trend will lead to a further aging of the RN workforce because the largest
cohorts of RNs will be between age 50 and 69 years. Within the next 10 years,
the average age of RNs is forecast to be 45.4 years, an increase of 3.5 years
over the current age, with more than 40% of the RN workforce expected to be
older than 50 years. The total number of full-time equivalent RNs per capita
is forecast to peak around the year 2007 and decline steadily thereafter as
the largest cohorts of RNs retire. By the year 2020, the RN workforce is forecast
to be roughly the same size as it is today, declining nearly 20% below projected
RN workforce requirements.
Conclusions The primary factor that has led to the aging of the RN workforce appears
to be the decline in younger women choosing nursing as a career during the
last 2 decades. Unless this trend is reversed, the RN workforce will continue
to age, and eventually shrink, and will not meet projected long-term workforce
requirements.
This review will explore the lived experience of the transition of new nursing graduates in their first year of practice, the implications to nursing and consequences of status quo, and actions required to support new graduates in their transition to practice.
The new graduate eagerly anticipates their first position in the 'real world' but often experience challenges in their first year of practice.
A literature review highlights the historical inaction and the confirmed lived experiences of new graduate nurses.
New graduate transition into the workforce has implications on both an individual and societal level. No longer can one ignore the need to recruit and retain nurses, especially new graduates.
Implemented collaborative and innovative efforts are required to support new graduate nurse transition to practice.
Nurse Managers must question why the disenfranchisement and marginalization of new graduates continues. Persistent inertia impacts recruitment and retention of graduate nurses and patient safety, transforming episodic challenges into chronic systemic issues. This article will contribute to new nursing knowledge by providing a Canadian perspective of demographic trends of the Registered Nurse (RN) and salient actions required to resolve the discourse of new graduate transition into the workplace.
As everyone is well aware, we are in the midst of a nursing shortage-one with no end in sight at the present time. But are you aware that we also have a shortage of nursing faculty? This article will briefly describe the current and predicted shortage of faculty, potential reasons for the shortage, current ways of coping, and the future for nursing faculty.
This article describes one university's experience in creating a master's geriatric clinical nurse specialist-nurse educator program to address the nursing faculty shortage and the need for geriatric clinical nurse specialists. The successes and challenges are outlined, and curricular ideas that may be beneficial to other nursing programs also are presented. This program has enhanced the university's pool of clinical instructors, increased its ability to provide services to older adults, and allowed faculty to instruct and focus undergraduates in the distinctions of geriatric nursing care. The biggest challenges faced were marketing and recruitment of nurses; these challenges were addressed, and possible solutions are offered. The most immediate benefit of this program was the generation of geriatric clinical nurse specialists.
Preparing nursing graduates for entry into practice is a priority for academic and healthcare institutions. To effectively prepare competent entry-level practitioners, it is important to understand clinical agency expectations. Most clinical agencies utilize some form of a precepted orientation experience for new graduate nurses. The purpose of this study was to examine preceptors' perceptions of the competence of new graduate nurses. Data analysis indicated several areas of weakness in new graduate nurses' clinical skills. This information can be used by academic nursing programs to revise clinical experiences to better prepare graduates for entry into practice. Findings can also be utilized to assist healthcare institutions with designing orientation programs for new graduate nurses. Suggestions are provided to help train preceptors for their important role. It is essential, particularly in today's complex healthcare environment, that strategies be explored to facilitate success of the emerging nursing workforce.
The purpose of this study was to gain insight into the transition period of graduate nurses. A phenomenological research approach was used to explore the lived experiences of graduate nurses during their first year of employment. Content analysis resulted in five thematic areas identified as indicators of a positive transition experience. The findings of this study provide information for staff development instructors, nurse managers, and nurse administrators in identifying practice environment characteristics and initiatives that promote a positive transition period for graduate nurses and increased retention in initial areas of nursing practice.
New graduate nurses now comprise more than 10% of a typical hospital's nursing staff, with this number certain to grow given the increasing numbers of entrants into the nurse workforce. Concomitantly, only 10% of hospital and health system nurse executives believe their new graduate nurses are fully prepared to provide safe and effective care. As part of a multipronged research initiative on bridging the preparation-practice gap, the Nursing Executive Center administered a national survey to a cross section of frontline nurse leaders on new graduate nurse proficiency across 36 nursing competencies deemed essential to safe and effective nursing practice. Based on survey data analysis, the authors discuss the most pressing and promising opportunities for improving the practice readiness of new graduate nurses.
b>Background: Time pressure and, occasionally, suboptimal assessment decisions are features of nursing in acute care.
Objectives: To explore the effect of generic and specialist clinical experience on the ability to detect the need to take action in acute care and the impact of time pressure on nurses' decision-making performance.
Methods: Experienced acute care registered nurses (n = 241) were presented with 50 vignettes of real clinical risk assessments. Each vignette contained seven information cues. In response to these vignettes, nurses had to decide whether to intervene or not. The 26 vignettes were time limited and mixed randomly into the 50 cases. Signal detection analysis was used to establish nurses' performance, personal decision thresholds ([beta]), and their abilities (d') to distinguish a signal of clinical risk from the clinical noise of noncontributory information.
Results: Nurses had significantly lower d' and were significantly less likely to indicate intervening under time pressure. For ability-but not threshold-there was a significant interaction of time pressure and years of experience in acute care. With no time pressure, d' increased in line with years of experience. Under time pressure, there was no effect.
Discussion: Time pressure reduced nurses' ability to detect the need and the tendency to report intervening. Thus, there were more failures to report appropriate intervention under time pressure, and the positive effects of clinical experience were negated under time pressure. More and larger scale research on the effect on clinical outcomes of time pressured nursing choices is required. <br /
Differences of opinion exist between nurses 'in service' and nurses 'in education' in all Westernized democracies with respect to their expectations of new graduate and diplomate Registered Nurses (RNs). Nurses in service complain that graduates and diplomate RNs are inadequately prepared for service provision at time of graduation. They complain, in particular, that graduates and diplomats have insufficient clinical and patient management skills. In contrast, nurses in education claim to prepare 'beginning' rather than competent practitioners, who are critically reflective and committed to lifelong learning. They also complain that service colleagues could do more to ease the transition experiences of new RNs. These differing views, the conceptualizations of nurse education and the socioeconomic pressures which underpin them will be explored in this paper. It will be argued that more intersectoral collaboration in terms of both pre-registration and transition programmes could result in the graduates'/diplomates' expeditious acquisition of clinical and patient management skills.
Practice errors by nurses can cause harm to patients, families, practitioners, systems, and the profession. Because the nursing errors reported to the State Boards of Nursing are typically serious, analyzing their data has great potential for developing new strategies to reduce dangerous errors. With the guiding rationale being identification of categories central to the nurse's role and function in healthcare delivery errors, 21 case studies of nursing errors from 9 State Boards of Nursing files were analyzed to develop a taxonomy of nursing errors. Eight categories of nursing errors representing a broad range of possible errors and contributive or causative factors were identified: lack of attentiveness; lack of agency/fiduciary concern; inappropriate judgment; lack of intervention on the patient's behalf; medication errors; lack of prevention; missed or mistaken MD/healthcare provider's orders; and documentation errors. Causes for the error, at the system and practice responsibility levels, were identified in each case. The categories, an assessment of causes of errors, and an examination of the remediation actions taken were the first steps in devising a taxonomy of nursing error, designed with prevention in mind. The authors discuss their work and present the taxonomy.
The process of planning the clinical rotations for nursing students can be challenging for both academia and the clinical service setting. This article will discuss a collaborative model that is used by one nursing community. Advantages and challenges will be presented from both views as well as lessons learned. The Clinical Placement Consortium (CPC) has served as a method to work toward a common goal of quality clinical experiences for all students.
To review estimates of U.S. nurse supply and demand, document trends in nurse immigration to the United States and their impact on nursing shortage, and consider strategies for resolving the shortage of nurses in the United States without adversely affecting health care in lower-income countries.
Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations.
Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.
Report of Findings from the Practice and Professional Issues Survey: Fall 2004 New graduate transitions: leaving the nest, joining the flight
- K Kenward
- E Zhong
Kenward K. & Zhong E. (2006) Report of Findings from the Practice and Professional Issues Survey: Fall 2004. National Council of State Boards of Nursing, Chicago, IL. Morrow S. (2009) New graduate transitions: leaving the nest, joining the flight. Journal of Nursing Management 17, 278– 287.
The Checklist Manifesto: How to Get Things Right Helping novice nurses make effective clinical decisions: the situated clinical decision-making framework
- A Gawande
Gawande A. (2009) The Checklist Manifesto: How to Get Things Right. Henry Holt and Co., New York, NY. Gillespie M. & Peterson B.L. (2009) Helping novice nurses make effective clinical decisions: the situated clinical decision-making framework. Nursing Education Perspectives 30, 164–170.
Report of Findings From the 2001 Employers Survey. National Council of State Boards of Nursing Medication errors and difficulty in first patient assignments of newly licensed nurses
- J Smith
- L Crawford
Smith J. & Crawford L. (2002) Report of Findings From the 2001 Employers Survey. National Council of State Boards of Nursing, Chicago. Smith J. & Crawford L. (2003) Medication errors and difficulty in first patient assignments of newly licensed nurses. JONAS Healthcare Law, Ethics and Regulation 5, 65–67.
The effects of time pressure and experience on nurses’ risk assessment decisions
- Thompson
Assessing new graduate nurse performance
- Berkow