“If somebody just showed me once how to do it”: How are workplace cultures and practice development conceptualised and operationalised for early career nurses?

BackgroundAn imminent nursing shortage mandates attention to retention of early career nurses. One factor that impacts on intention to stay in the profession is the ability to do the work. Early career nurses rely on supportive cultures to develop the practical skills and knowledge specific to particular workplaces.ObjectivesThis study was conducted to determine the impact of workplace culture on practice development for early career nurses.MethodsWe undertook a qualitative study using semi-structured interviews conducted with eleven early career nurses at a single metropolitan hospital in Melbourne, Australia. Interviews were transcribed verbatim and analysed using thematic analysis techniques.ResultsThemes identified were learning in the moment, active welcome, confidence, ambiguities in the culture of learning, bullying and navigating the space.ConclusionsEarly career nurses conceive practice development as the acquisition of skills and knowledge particular to the immediate needs of their patients, which they learnt by asking questions. Developing confidence was integral to all aspects of practice development. Complexity and risk on the wards could negatively impact on confidence. Where welcome was explicit and overt the nurses felt that practice development was facilitated. Transition to practice programs supported nurses and some individual nurses were active in assisting nurses to develop. However, workplace cultures were at times indifferent to the learning needs of the early career nurses and some experienced poor workplace behaviour and bullying.     

Effects of board game play on nursing students’ medication knowledge: A randomized controlled trial

AimThis study aimed to examine the effectiveness of an educational board game in improving nursing students’ medication knowledge.BackgroundMaintaining patient safety is a core practice for nurses. Medication management is a central principle of patient safety. Nurses acquire pharmacology knowledge and medication safety skills in the classroom training. Thus, solidifying and strengthening nursing students’ medication knowledge are crucial tasks for nursing faculty members. In recent years, board games, which offer both entertainment and competitive play, have been employed to educate students in a variety of disciplines and settings. Through board game play, students can learn in an enjoyable and fun atmosphere.DesignA randomized controlled trial design.MethodsA convenience sample of 69 nursing students was obtained from a university in Taiwan. Participants were randomly assigned either to an experimental (board game) group (n = 35) or a comparison group (n = 34) using block randomization. The experimental group engaged in board game play to learn about medications, whereas the comparison group attended a one-hour didactic lecture. Using questionnaires, data were collected before the intervention, immediately post intervention and one month post intervention.ResultsFollowing the intervention, regardless of the learning method, both groups showed significant improvements in their immediate recall of medication information. However, when retested after one month, the experimental group obtained significantly higher scores than the comparison group. Moreover, students in the experimental group reported more satisfaction with the learning method than those in the comparison group.ConclusionsThe study results suggest that learning through board games could enhance nursing students’ retention of knowledge. Students reported favorable reactions to using a board game learning method for increasing knowledge of medication. With respect to this finding, faculty members may consider employing board games as teaching tools in nursing and other health science courses. Moreover, the findings of this study can also provide additional information for nursing managers in hospital wards or long-term care facilities where nurses are trained to familiarize themselves with frequently administered medications.Tweetable abstractBoard game play can enhance nursing students’ retention of knowledge; students reported positive reactions to game-based learning for medication training.     

The effectiveness of an education program on nurses’ knowledge of electrocardiogram interpretation

ObjectivesThe aim of the study was to evaluate the effectiveness of a continuing education program on nurses’ knowledge of interpretation of 12-lead electrocardiograms (ECGs).MethodsThe study used a quasi-experimental design. Fifty-two nurses, including 23 nurses working in an emergency department, 12 nurses working in a cardiology department and 17 nurses working in an intensive care unit (ICU) were recruited for the study. Two learning methods were used: a lecture-based education program and a self-learning handbook. The effectiveness of the methods was evaluated using a questionnaire containing questions in five domains.ResultsData analysis showed that before training, nurses who worked in the cardiology department scored higher in basic ECG knowledge than those in the emergency department and ICU; test scores of nurses who had worked for 2–10 years were higher than else. The post-test total and domain scores at 2 weeks, and 4 months after the lecture-based learning and 1 month after a self-learning ECG handbook was presented were higher than the pretest scores.ConclusionsPrior to training, ECG knowledge differed with respect to the nurses’ different demographic characteristics. The lecture-based education program and self-learning handbook material were effective in improving the nurses’ ECG knowledge.     

Nurses' immediate response to the fall of a hospitalized patient: A comparison of actions and cognitions of experienced and novice nurses

BackgroundFalls represent a significant threat to patient safety for hospitalized patients throughout the world. Little is known, however, regarding nurses’ immediate responses to the discovery of a fallen patient.ObjectivesThe objective of this study was to perform an experimental examination of experienced and novice nurses’ reaction to the discovery of a fallen patient who has sustained a closed head injury.DesignThe study was based upon the expert performance approach, which utilizes a mixed methods approach to determining performance characteristics of individuals performing in a variety of domains.SettingThe study was accomplished using a simulated task environment developed specifically for research concerning the performance of health professionals.ParticipantsThe study included 12 experienced and 10 novice nurses, all of whom were currently employed in critical care settings.MethodsThe study used directly observed performance, which was quantified through the use of direct coding of clinical behaviors and the analysis of verbal reports of thought.ResultsThe data indicate that experienced participants were not only more likely to call for help but that they were more likely to precede this action by checking for responsiveness, and then, after calling for help, establish the effectiveness of the patient's airway, breathing and circulation. These data confirmed that experienced participants were more likely to engage in the appropriate sequence of actions when faced with this unexpected and highly stressful situation.ConclusionsNovice nurses’ superficial assessment of the situation and subsequent failure to react properly implied an overall pattern of superior performance by the experienced nurses. The results indicated that, compared with novice nurses, experienced nurses are more likely to initiate standard treatment protocols in situations such as the one reported in this study.     

Understanding new nurses’ learning experiences in intensive care

ObjectivesRecruitment and retention of nurses in intensive care units (ICU) has been challenging over the last few years. Rising demand is now exacerbated by the ongoing Covid-19 pandemic. Transition to ICU from other clinical areas is stressful resulting in significant nurse retention issues. This study therefore aimed to illuminate and explore new nurses’ learning experiences in one large intensive care unit in the United Kingdom.Methodology/MethodsExploratory qualitative case study utilising two data collection methods: one to one interview with six new ICU nurses and focus groups with six senior/clinical education ICU nurses.SettingA large major trauma centre in London with over ninety ICU beds.FindingsFindings indicate that ICU is a challenging learning environment for new nurses due to the large number of skills which must be developed in a short period of time. Forming supportive social relationships proved important in helping new ICU nurses learn and adapt to this complex clinical environment. The high-risk culture of ICU makes it harder to learn particularly for internationally educated nurses. Frequently changing shift patterns also impacts learning.ConclusionSenior ICU nurses should be aware of the issues affecting new nurses and where possible alleviate the stress of working in this challenging environment. They should also consider individual circumstances whilst maintaining high quality education. Social support should be facilitated where possible and new nurses need to be aware of the realities of ICU work.     

Onboarding orientation for novice nurse faculty: A quality improvement pilot project

BackgroundNovice nurse faculty have a challenging time transitioning into academia, resulting in reduced satisfaction and retention. After conducting a thorough literature review, it was determined that formalized mentoring combined with professional development workshops could improve the transition into academia, thus improving the satisfaction and retention of novice nurse faculty.MethodsIn fall 2020, an onboarding orientation program for novice nurse faculty was implemented. The objectives included matching mentoring dyads based on similar interests and goals, developing mentoring guidelines, implementing the Department of Nursing (DON) Orientation Checklist, and providing five monthly professional development workshops with topics ranging from creating learning objectives to the promotion and tenure requirements. Five novice nurse faculty participated in the study, and each was matched with a mentor with similar goals.ResultsAfter 6 months of project implementation, overall faculty satisfaction dropped slightly from 4.1 to 4.0. A dependent t-test (p = 0.83) and Wilcoxon signed ranks test (p = 0.461) both indicated no significant difference in satisfaction post project implementation. Although, the results indicate the novice nurse faculty and mentors agreed that the program was effective and should continue. The novice nurse faculty reported that the DON Orientation Checklist, mentoring relationships, and professional development workshops contributed to their successful transition into academia. Retention was 100% 2 years after project implementation. One significant factor noted after program evaluation was conducted is that there should be regular meetings with mentors to support them in their role.ConclusionsThe onboarding orientation program for novice nurse faculty was an effective strategy to ease the transition into academia and maintain satisfaction within the role.     

Learning Curve for Automated Ultrasound Cystovolumetry in Patients With Localized Prostate Cancer

PurposeThe purpose of this study was to investigate the learning curve of automated ultrasound cystovolumetry in novice radiation nurses and to determine how much experience is required before reliable measurements can be obtained.MethodFive consecutive patients with localized prostate cancer who underwent intensity modulated radiation therapy were included in this study. Immediately before each irradiation, three novice radiation nurses with no experience in ultrasonography measured urinary bladder volume using an automated ultrasound cystovolumetry system (CUBEScan). Changes in the relative error of bladder volume were examined.ResultsThe mean value of the relative error decreased and became constant after the third irradiation, that is, the fifteenth measurement. The mean value of the relative error from the first to the third irradiation was 0.12 ± 0.03 (mean ± standard deviation [SD]), whereas that from the fourth to the tenth irradiation was 0.05 ± 0.03 (mean ± SD) (p = .03).ConclusionIt takes at least 15 measurements for a novice radiation nurse to be able to accurately measure bladder volume using the automated ultrasound cystovolumetry system.     

Compassion: Use it or lose it?: A study into the perceptions of novice nurses on compassion: A qualitative approach

BackgroundNurses and patients believe compassion to be one of the most important professional values. However, it is not known which factors influence compassionate behaviour in practice. There is a need for insight whether or not compassion in nursing practice flourishes or falters.ObjectivesThis study aims to explore how Dutch novice nurses perceive compassion within nursing care and gain insight in their strategies of sustaining and developing compassionate care.DesignThis study used an exploratory design, employing a qualitative approach.Data Sources14 in depth interviews with Dutch bachelor novice nurses with 0–5 years of practical experience took place.Review MethodsThematic analysis and inductive coding was used.ResultsFour themes emerged from the data. First, participants perceive compassion to be a part of their professional identity. Balancing between positive and negative environmental influences and their own perceptions was shown as a second theme. Thirdly, various strategies such as rebellion and conforming to the ideas on the workplace helped nurses to do so in daily practice. If nurses succeeded in dealing positively with various influences, a professional development was perceived over time. The fourth theme described the increased awareness of compassion and professional identity if strategies were successful. If not; insecurity, job dissatisfaction and ultimately consideration of job-retention was described.ConclusionCompassion is an essential value during the development of the professional identity of novice nurses. Dealing with meaningful emotions and experiences broadened nurses' personal awareness of compassionate care and stimulated a growth in their professional identity. Novices need support during their internships that builds empowerment and resilience in sustaining compassion. Furthermore, there is a need for role models and a corporative team spirit in order to coach novice nurses in compassionate behaviour.     

Novice nurses’ transition to the clinical setting in the COVID‐19 pandemic: A phenomenological hermeneutic study

BackgroundThe COVID-19 pandemic both exposed and increased weaknesses in the healthcare system, so that novice nurses have become a more vulnerable group during this context.AimThis study sought to illuminate experience of novice nurses in providing care during the COVID-19 pandemic.MethodIt consists of a qualitative study conducted with data collected by means of semistructured interviews, audio recorded, transcribed, anonymised, and analysed in the light of the phenomenological hermeneutic approach. Fourteen registered novice nurses from two health areas in northwest of Spain, being twelve women and two men, who experienced the COVID-19 pandemic within their first five years of professional experience, were selected through a non-statistical snowball sampling.ResultsAfter analysing the narratives, we identified four main themes: “Transitioning to a hostile, unknown and uncertain clinical setting from inexperience,” “Invisible wounds because of being on the front line,” and “Healing to return to the front line.”DiscussionThe uncertainty of an unknown illness and the lack of support during the COVID-19 pandemic has been affecting novice nurses, impacting their health conditions. At the same time, this context created opportunities for professional development. According to the interviewees, self-care and social support were elements to cope with exhaustion.ConclusionOur study investigates the experiences of a group barely approached in the literature, highlighting the reality and difficulties of these nurses in transitioning to the clinical setting and providing insights to managerial leaders and educators.     

Novice nurses’ experiences from teamwork in the emergency department: A qualitative content analysis

Background and aimTeamwork is assumed crucial in nursing. Nevertheless, nursing shortages in medical centers have thus far compelled nurse managers to use novice nurses. The present study aimd to explaining the challenges and experiences of novice nurses regarding teamwork in emergency departments.Materials and methodsUsing qualitative content analysis, 11 novice nurses working at emergency department, participated in this study. Data were collected with semi structured interview and analyzed by Graneheim and Lundman.ResultsThe data analysis led to the emergence of four themes of “essential teamwork skills development”, “contradictory relationships between team members”, “unpleasant feelings and experiences”, and, “personal growth and maturation during teamwork”.ConclusionFostering different personal aspects as prerequisites for teamwork, novice nurses will be able to deal with unpleasant feelings and experiences as well as contradictory relationships between team members in an effective manner. This challenging experience will thus give rise to personal growth and maturation during teamwork among them in emergency department.     

Individual resilience,intention to stay,and work frustration among postgraduate two-year programme nurses

BackgroundThe high stress of the nursing profession can easily produce work frustration that affects the nurse’s intention to stay in his or her employment. As a result, there is a serious shortage of nurses.AimTo investigate the relationship between resilience, intention to stay, and work frustration in postgraduate two-year programme nurses (PGY nurses) and the mediating effect of work frustration.MethodsA cross-sectional design was adopted. The PGY nurses of two hospitals in central and southern Taiwan were selected as research subjects. Structured questionnaires that addressed resilience, intention to stay, and work frustration were administered and analysed. A total of 390 valid questionnaires were collected. The response rate was 92.19%.FindingsWork frustration had a significant negative impact on intention to stay (p < 0.01) and a partial mediating effect on resilience and intention to stay (p < 0.001).ConclusionThe professional skills and practical clinical experience of PGY nurses are insufficient. To increase the retention rate of novice nurses, institutional administrators should establish comprehensive support systems, including diversified training programmes, to enhance work enthusiasm, self-growth, professional commitment, job satisfaction, and staff cohesion and solidarity.     

Expertise among critical care nurses: A grounded theory study

ObjectivesExplore critical care nurses’ personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice.DesignFollowing constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process.SettingA multi-site urban area in the southeastern United States.Participants10 certified critical care nurses, three males and seven females, with 10–30+ years of critical care experience.FindingsExperience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses’ aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care.ConclusionKey findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse’s trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.     

The novice nurse and clinical decision-making: how to avoid errors

saintsing d., gibson l.m. & pennington a.w. (2011) Journal of Nursing Management  19 , 354–359
The novice nurse and clinical decision-making: how to avoid errors Aim 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. Background 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. Evaluation Articles selected included information regarding types of errors, causes of errors and potential interventions for the novice nurse. Key issues 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. Implications for nursing management 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.     

A web-based clinical pedagogy program to promote professional development for nurse preceptors: A quasi-experimental study

ObjectiveTo examine the effectiveness of a web-based clinical pedagogy program on nurse preceptors’ clinical teaching competency, self-efficacy, and attitudes toward web-based learning in comparison to face-to-face course.BackgroundPreceptorship is a dynamic educational process that requires designing, and implementing various teaching strategies, evaluation, assessment and feedback. Web-based learning has been recognized as an effective learning approach for nursing professional development.DesignA prospective quasi-experimental approach with two-group pre-test and post-test repeated measures was adopted.MethodsThe web-based clinical pedagogy program was provided to the preceptors in the experimental group, while control group received the face-to-face preceptorship course. Clinical Teaching Competence Inventory (CTCI), Preceptor Self-efficacy Assessment Instrument (PSEQ), and Attitudes toward Web-based Continuing Learning Survey (AWCLS) were used to evaluate preceptors’ learning outcomes. Data were collected at three time points – before, immediately after the learning program, and after 6 months of the clinical teaching experience.ResultsA total of 150 nurses (75 participants/group) were recruited from a tertiary hospital in Singapore from July 2018 to June 2020. The results from the repeated measures analysis of covariance showed that there was a significant interaction effect (group x time) on the overall CTCI score after adjusting for covariate (F = 5.390, p = 0.005). However, there were no significant interaction effect (group x time) on PSEQ (F = 2.693, p = 0.070) and overall AWCLS score (F = 1.341, p = 0.264) between the two groups across the three time points.ConclusionThe web-based clinical pedagogy program produced outcomes comparable to the face-to-face program in terms of preceptors’ clinical teaching competence and self-efficacy. The innovative and cost-effective web-based clinical pedagogy program provided professional development and the flexibility to accommodate preceptors’ busy work schedules. Online learning has become increasingly popular during the COVID-19 pandemic and the web-based clinical pedagogy program was implemented when face-to-face workshop was not feasible.     

Factors affecting turnover of Japanese novice nurses in university hospitals in early and later periods of employment

suzuki e ., tagaya a ., ota K ., nagasawa Y ., matsuura r . & sato c . (2010) Journal of Nursing Management 18, 194–204
Factors affecting turnover of Japanese novice nurses in university hospitals in early and later periods of employment Aim To explore the factors affecting turnover of novice nurses during the 10th–15th months of employment in comparison with those during the preceding 6 months. Background The early turnover of novice nurses is a serious issue. Our previous study showed that 4.0% (37/923) of novice nurses quit their jobs in the initial 3rd–9th months of employment. The major determinants of their turnover were education (i.e. graduation from vocational nursing schools), undesired ward assignment and lack of peer support. Methods The cohort of 762 novice nurses from our previous study was followed up during the next 10th–15th months of employment. Their turnover in this period was predicted using variables from baseline data such as demographic attributes, burnout (J-MBI), assertiveness (J-RAS) and perceptions about the workplace. Results The findings showed that 4.6% (35/762) of novice nurses quitted their jobs during the first 15-month period. The factors affecting the turnover were: burnout, dissatisfaction with the workplace and hospital location being in Tokyo. All these factors were different from those observed for the preceding follow-up period. Conclusion Burnout was revealed to be the most significant factor affecting the turnover of novice nurses. Implications for nursing management Nurse managers should be vigilant and exercise care in the prevention of burnout among novice nurses.     

Blended Oncology Nursing Training: A Quality Initiative in East Africa

PurposeLack of education and awareness about cancer treatment may result in suboptimal care of patients with cancer. Unlike high-income countries, resource-limited countries lack the standardized training and scope of practice in oncology nursing. This quality improvement project was conducted to assess nurses’ knowledge gain, retention of knowledge and clinical skill set, and feasibility of a blended learning approach in the care of adult oncology patients across four hospitals in Kenya and Tanzania.MethodWe used a combination of computer-led eLearning sessions and face-to-face interactions over 12 months for cancer education to oncology nurses. Pre- and posttests with each training session were combined with face-to-face clinical skills training at beginning and completion of the course. A comprehensive postassessment was conducted immediately after the training, and at 6, 9, and 12 months to evaluate knowledge gain and retention.ConclusionOf 21 participants across four sites, there was a statistically significant improvement in knowledge scores for 12 participants (P value < .05). The mean pre- and posttest results found significant differences across 10 sessions individually and cumulatively (P value < .01). Results from a one-way repeated measures analysis of variance (ANOVA) test on comprehensive test results suggested that there was no significant difference in knowledge retention across 9 months (F(2, 30) = 1.648412, P > .05).Implications for Nursing PracticeBlended learning is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in resource-limited countries. Developing a structured oncology training program has implications for bridging knowledge gaps among clinicians in resource-limited countries and promoting international knowledge exchange.