New graduate nurses’ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support

Abstract

BackgroundGiven the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is known about how change in new graduate nurses’ satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses’ perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences.MethodsUsing a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses’ working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8–10 weeks) and follow-up (10–12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single –item measures were used to rate new graduate nurses’ confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees.ResultsEighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses’ satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6, p = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629).Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence.ConclusionsWhile transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and ...

Good clinical support transforms the experience of new graduates and promotes quality care: A qualitative study

“…Newly registered nurses commonly commence their careers in hospital graduate nurse programmes (GNP) (Walker, Costa, Foster, & Bruin, 2016), also known as transitional support programmes (TSP) (Bloomfield, Gordon, Williams, & Aggar, 2015). These non-compulsory programmes support transition into the workforce through preceptorship, mentorship and clinical supervision (Hussein et al, 2017) and are recommended as a means of skill acquisition and credentialing (Missen, McKenna, Beauchamp, & Larkins, 2016). Despite wide use, NGN perceptions of their first practice year highlight continuing challenges for NGNs and the workplace environment at the point of care (Figueroa et al, 2016).…”

“…For NGNs, these include caring for patients with greater acuity, managing technological advancement and increasing workloads (Gilmour et al, 2017;Hussein et al, 2015;Parker et al, 2012). In acute care settings, reduced staff to patient ratios is an increasingly common experience (Hussein et al, 2017;Twibell et al., 2012). Despite TSPs, NGNs experience high levels of stress (Pineau Stam, Spence Laschinger, Regan, & Wong, 2015;Unruh & Zhang, 2014), leading to lack of confidence, feelings of inadequate preparedness (Hussein et al, 2017;Parker et al, 2012) and for some, a decision to leave nursing (Chachula, Myrick, & Yonge, 2015).…”

“…For this study, clinical support refers to the "informal" or "formal" clinical learning encounter between a bedside nurse and their immediate supervisor (Cleary, Horsfall, & Happell, 2010). The level of clinical support received by NGNs in TSPs' varies widely, but all share features such as preceptorship, mentorship and a defined resource person such as transition programme coordinator and clinical educator (Henderson, Ossenberg, & Tyler, 2015;Hussein et al, 2017;Rush, Janke, Duchscher, Phillips, & Kaur, 2019).…”

“…There are complex reasons for NGN attrition. Rapidly changing clinical environments result in repeated experiences of steep learning curves, high patient acuity (Figueroa, Gardner, Irizarry, & Cohn, 2016;Hussein, Everett, Ramjan, Hu, & Salamonson, 2017) and struggling amidst poor nursing skill mix (Parker, Giles, Lantry, & McMillan, 2012), exacerbated by staff shortages and lack of clinical support (Gellasch, 2015;Hussein et al, 2017;Roche, Duffield, Homer, Buchan, & Dimitrelis, 2015). These concerns are not new, but such challenges can have negative impacts on transition, retention and the quality of patient care.…”

Nursing Students Challenges at Educational and Clinical Environment

“…Clinical learning environment not only influences the educational goals, but also effect career choices of nursing students. Learning atmosphere reflects the accessibility to the unit staff interest in intern nurses' supervision and presence of meaningful and multidimensional learning situation (Hussein, Everett, Ramjan, Hu, & Salamonson, 2017).…”