In a Level II trauma center, experienced nurses are retiring from nursing positions, which is causing an unstable workforce. According to the literature, there are not enough experienced nurses to mentor the new nurses. Evidence suggests that experienced nurses are associated with improved patient outcomes and that experienced nurse mentors can improve the work environment for less experienced nurses. Focusing on Watson's theoretical framework of caring and Covell's theoretical framework of intellectual capital, this phenomenological study explored the lived experiences of a small group of nurses. Five nurses with 15 years of experience and who had served as mentors were selected for in-depth individual interviews. Open coding and thematic analysis were used to analyze the data, and 5 themes emerged: lengthening work shifts and related effects, increasing workload and responsibilities due to higher patient acuity, learning new technologies, mentoring with a decreased patient ratio, and surveying customers as the main focus of patient care. The results of this study guided the development of a proposal for a computer-based learning module on nurse mentoring. The module explains what mentoring is, the importance of mentoring, and proper ways to mentor. Implications for positive social change include retaining intellectual capital in an organization through mentoring positions for experienced nurses.

This research explores how experienced nurses perceive their role as clinical teachers in an environment that is challenged not only with on-going changes in healthcare delivery, but also by the expectation that it will continue to provide positive clinical learning opportunities for undergraduate student nurses. Schools of nursing in Australia have undergone rapid and far-reaching change as a consequence of the legislated transfer of nursing eduction to the tertiary sector. Expectations that nurse academics will possess higher degrees and be actively involved in research mean that faculty members have less time to be directly involved in their students’ learning during clinical practice placements. The literature indicates that the responsibility for moment to moment teaching and learning thus appears to have been implicitly given to clinical staff who may not possess any formal qualifications for teaching, yet are largely responsible for students’ learning through clinical placements. Indeed some clinicians report a worrying lack of knowledge of clinical supervision models giving cause for further concern about the nature of the clinical learning environment. Schools of nursing expect that clinical practica will provide opportunities for students to learn how to be a nurse through guided questioning, analysis and critical thinking. It is evident that in some settings, this represents an ideal situation and not the reality. Critical reflection on these issues has informed the purpose of this research and helped to shape the following questions that focus the conduct of the study: Research Question One. How do experienced nurses create positive clinical learning environments for student nurses? Research Question Two. How do experienced nurses resolve the often-contradictory demands of nursing students and those of the practice setting? Research Question Three. How do changes in the healthcare environment impact on the experienced nurse's role as a clinical teacher? The theoretical framework for this study was underpinned by the interpretive philosophies of hermeneutic phenomenology and symbolic interactionism, because they acknowledge the personal experiences and meanings of the participants. A case study approach was utilised because it acknowledges the given context of the participants. Data were collected from six experienced nurses through a series of semi-structured interviews, informal interviews and periods of participant observation supported by field notes and the researcher’s diary. Participants identified that their perception of their role as clinical teachers was constructed of three intersecting roles: that of facilitator of learning, assessor and socialiser. This study concludes that several factors influence these nurses’ perception of their role as clinical teachers. In particular, the positivist work culture of the clinical setting and nurses’ own past experiences and world view of nursing combine to shape these nurses’ perception of their role as clinical teachers. The research concludes that the expectations that students will be supported in their endeavours to be critically thinking, problem solving and reflective practitioners may, in fact, be unrealistic in the current, economically constrained, clinical environment. It is evident that experienced nurses, despite being willing to be involved with clinical teaching, have to function in rapidly changing environments that do not always offer opportunities for nurses to reflect on their practice. However, the creation of positive clinical learning environments in these circumstances requires an increased understanding and appreciation by both schools of nursing and their students of the impact of change on these nurses and their clinical environment. This appreciation may result in more effective collaboration between nursing education and nursing service to assist student nurses to learn not merely through repetitive practice and busywork, but also through opportunities to observe, question and understand their nursing practice.

Competency-based nurse orientation programs focus on the new nursing graduate and experienced nurse employees' ability to perform skills necessary in a new work setting. The purpose of this project was to develop a learner-focused and competency-based orientation program for new nursing employees at a large urban hospital to enhance patient safety and nurse retention. The Johns Hopkins nursing evidence-based practice model and guideline were used in the selection of articles with higher levels of evidence and research quality for the critical appraisal of literature in support of the program development. The best practices for nursing orientation content and delivery for positive effects on hospital finances, nurse turnover rates, and patient safety were the focus of the literature review. Benner's model of 5 levels of skill development was the theoretical framework for advancing skills of nurses who enter the orientation program with different expertise and skill sets. Nurse orientation materials and processes, comprising a collaborative team approach to orientation and a guideline for preceptor selection, were developed as the essential components for successful orientation at the project hospital. A nursing orientation based on the evidence may provide an infrastructure and operational process for the organization in developing the competencies of all levels of nurses, including experienced nurses transitioning to new units or duties. The social change resulting from the project will be a supportive and seamless transition of nurses into the new practice role and work environment. When implemented, this project is anticipated to increase nurse satisfaction, improve quality of health care delivery, decrease anxiety related to the new nursing role, and improve collegiality among all levels of nurses.

Syftet med studien var att beskriva yrkeserfarna sjuksköterskors upplevelser av att arbeta med och stödja nyutexaminerade sjuksköterskor. En kvalitativ och beskrivande design användes. Undersökningsgruppen bestod av åtta kvinnliga sjuksköterskor från ett sjukhus i mellansverige. Huvudresultatet visade att de yrkeserfarna sjuksköterskorna var nöjda med nyutexaminerade sjuksköterskors arbetsinsats. En viktig aspekt var att nyutexaminerade sjuksköterskor frågade vid osäkerhet för att känna tillit. Sjuksköterskorna ansåg att stöd och uppskattning för att komma in i arbetet och gemenskapen var viktigt för att nyutexaminerade sjuksköterskor skulle känna sig trygga. Trots att sjuksköterskorna upplevde att nyutexaminerade sjuksköterskor var snabblärda, duktiga och nyfikna på att ta in ny lärdom i yrket, kom det dock fram att det fanns svårigheter att fokusera och prioritera rätt. Genomgående ansågs nyutexaminerade sjuksköterskor fokusera mer på dokumentation än omvårdnadsarbetet. Sjuksköterskorna betonade att mer praktik behövdes i grundutbildningen för att bättre förbereda nyutexaminerade sjuksköterskor i klinisk verksamhet. Vidare framkom det att längre introduktionstid behövdes i klinisk verksamhet för att komma in i rutinerna och sjuksköterskerollen. Slutsatsen visade att yrkeserfarna sjuksköterskor var nöjda med arbetsinsatsen från nyutexaminerade sjuksköterskor. Det ansågs viktigt att fråga vid osäkerhet och att mer fokus behövdes på omvårdnadsarbetet. Mer praktik ansågs nödvändigt för att lättare klara av den kliniska verksamheten. / The aim of the study was to describe professional experienced nurses' experiences of working with and supporting newly qualified nurses. A qualitative and descriptive design was used. The study group consisted of eight female nurses from a hospital in central Sweden. The main results showed that the professional experienced nurses were satisfied with the graduates’ nurses’ job performance. An important aspect was that newly qualified nurses asked if unsure to feel confident. The nurses felt that support and appreciation to get into work and community was important for newly qualified nurses to feel safe. Although the nurses felt that newly qualified nurses were quick to learn, skilled and curious to take on new learning in the profession, was however shown that there were difficulties to focus and 0Tprioritize the right0 Consistentlyconsidered graduates nurses to focus more on documentation than nursing. The nurses emphasized that more training was needed in basic education to better prepare graduate nurses for clinical practice. It was also found that longer introduction where needed in clinical practice to get into the routine and the nursing role. The conclusion showed that experienced nurses were satisfied with the effort from newly graduates’ nurses. It was considered important to ask if in doubt and that more focus was needed on nursing. More training was needed to help manage the clinical operations.

Aims and objectives: To describe newly graduated nurses’ experiences of the intervention practitioner training nurse.  Background: Newly graduated nurses need support to establish the profession. Several studies have shown that the first years in the profession, is the most challenging time. Method: The intervention practitioner training nurse was initiated to empower, and support newly graduates nurses in their professional role. Data were collected through semi-structured interviews with ten newly graduate nurses having experience of the intervention. The data were analysed using qualitative content analysis. Results: The analysis results in the overarching theme; “Organizational prerequisites” The theme consisted of three categories, "Activator" comprised the subcategories compiliating and attractive workplace. This involved that the practitioner training nurse were the activator creating a clear structure and the wards became more attractive workplaces. “Supportive nursing" comprised the subcategories present assistance, emotional support, and patient safety. This involved that practitioner training nurse constituted an important support function and helped to ensure patient safety. “Professional development” comprised the subcategories nurse's competence, feeling of security, and learning. This created the opportunity for professional development. Conclusion: The newly graduate nurses' experience of the intervention shows that the creation of an organisational structure enabled the practitioner training nurse to be an important support and to contribute to professional development. This was accomplished by strategic decision of the hospital management. Relevance to practice: The results of the current study can be transferred to other similar healthcare organizations and can be a support for managers who plan to initiate interventions to empower and support newly graduated nurses.