Combining clinical practice and education in critical care nursing—A trainee program for registered nurses

Abstract

Aim The aim of this study was to describe the experiences of a master's‐level critical care nursing program for trainees in postoperative and intensive care units. Design An exploratory design with a multidimensional approach was chosen. Methods The study was conducted from 2018 to 2019 at a university hospital in southern Norway in collaboration with a university college of nursing. Data were collected through seven focus group interviews with trainees, preceptors, heads of departments, clinical nurse educators and professors ( n = 26). The thematic analysis progressed from description to a deeper understanding, searching for manifest and latent patterns across the data. The COREQ checklist was used for reporting the study. Results The analysis resulted in one overarching theme: ‘To walk the critical care nursing pathway – balancing competency, time, and challenges to become proficient’. The subthemes were ‘expectations, obligations, and workload in unknown environments’, ‘constantly assessing while being assessed’, ‘continuous precepting and challenges’, ‘vulnerability and commitment’ and ‘thriving in the role, mastering new skills’. The study provides valuable insights into a complex learning environment and the importance of caring aspects for trainees during their critical care nursing education. Conclusion Precepting, continuous competence assessment and clear learning outcomes are necessary to create a safe environment for the trainees during their development. Implications for the profession The results advocate investing in inexperienced trainees' competency development to become proficient, creating a safe learning environment in a highly complex setting. This may also, as previous studies suggest, increase staff retention.

Organizational socialization

“…Durbin and colleagues noted similar differences regarding communication and collaboration when comparing a hospital with an established physician residency program and a hospital with a new program 33. These results are concerning given the significance of these skills and interactions in patient care 10. Consequently, preceptors should be well prepared to assess the comfort level of ERNs in interdisciplinary communications, effectively address role expectations in this regard, and actively coach ERNs on effective communication behaviors.…”

“…33 These results are concerning given the significance of these skills and interactions in patient care. 10 Consequently, preceptors should be well prepared to assess the comfort level of ERNs in interdisciplinary communications, effectively address role expectations in this regard, and actively coach ERNs on effective communication behaviors.…”

“…Wallander Karlsen and colleagues detail the complexities of precepting in critical care settings, but the same stressors are present in any clinical environment where precepting occurs simultaneously with meeting the demands of direct patient care. 10 The current staffing shortage has exacerbated the situation, as nurses are asked to precept new staff more frequently, but there are fewer experienced staff members available to serve as preceptors. 27 Transition.…”

“…NPDPs understand the impact of onboarding on retention, job satisfaction, and performance and have a fundamental role in this process. 2,4,9,10 Indeed, it was the preponderance of evidence regarding the significance of professional socialization and onboarding on NLRN retention that motivated many hospitals to initiate year-long professional residency programs. [11][12][13][14] In contrast, the onboarding process for non-NLRNs (such as ERNs) is abbreviated and seldom explored, so there's limited evidence available on how to effectively address the needs of this group.…”

“…Nurses are required to participate in some degree of orientation when entering a new organization or transferring to a new work unit. NPDPs understand the impact of onboarding on retention, job satisfaction, and performance and have a fundamental role in this process 2,4,9,10. Indeed, it was the preponderance of evidence regarding the significance of professional socialization and onboarding on NLRN retention that motivated many hospitals to initiate year-long professional residency programs 11-14.…”