Aims and objectives
To examine how experienced registered nurses in direct patient care learn within the constantly changing contemporary healthcare environment. The key objectives were to examine educational interactions amongst workplace, nurse and nursing practice, with a focus on the influence of context.
Background
Registered nurses must maintain competence throughout their careers. The related ongoing learning is triggered by external demands and nurses’ internal motivation. Experienced nurses, poised to retire, have worked through the recent tumultuous changes in health care and therefore provide insight into how they sustained excellent patient care.
Design
The methodology for this study was a grounded theory informed by symbolic interactionism. EQUATOR guidelines for qualitative research (COREQ) applied.
Methods
Data collection entailed semi‐structured interviews with experienced nurses across diverse settings and participant observation on two acute care units. Analysis of data was conducted using three‐level coding, constant comparison, theoretical sampling and extensive memoing.
Results
Refining nursing practice begins during nursing education and early employment. Getting grounded involves establishing key capabilities, specifically becoming self‐aware, setting high standards, cultivating healthy apprehension and seeing the whole patient picture. Three catalysts for workplace learning are mentor‐guides, workplace camaraderie and a highly functional workplace team. Refining nursing practice includes both formal and informal learning; however, significant nursing expertise is developed through puzzling and enquiring, an iterative process of learning while nursing.
Conclusions
Facilitating the development of capabilities for nurses’ workplace learning during nursing education and early work experiences contributes to excellent patient care. Healthcare organisations need to value and support the unique contributions of mentor‐guides in the clinical setting and promote individuals’ development of expertise by nurturing camaraderie and developing highly functional workplace teams.
Relevance to clinical practice
Attending to the processes and catalysts for nurses’ workplace learning will contribute to excellent patient care.
Within a context of healthcare restructuring and a shift toward individualized continuing competency in Canada, this inductive, narrative inquiry explored positive learning experiences of first-line acute care nurses. The written stories of eight self-selected participants were collected and unstructured follow-up interviews were conducted. The stories and interview transcripts were examined using categorical-content and holistic-form analysis, and analyzed in light of literature relating to adult education and professional development in nursing. Emergent themes included life-changing learning and learning through one's own, and other's, experiences. The findings highlight the need to re-frame professional development for nurses in Canada, specifically by valuing and utilizing shared workplace experiences.
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