The transition from student to new graduate nurse is a difficult conversion. The challenges of the new graduate are the demanding workload, lack of clinical skills, and incivility from staff nurses and unfamiliar institutional cultures. More than 40% of new graduate nurses report making medication errors and feel unprepared to recognize and intervene in life-threatening complications that keep the patient safe from harm. Preceptorship is a clinical instructive model in which a professional relationship provides new graduate nurses with access to a clinical expert and role model within a preset time frame. The goal of the program was to evaluate the outcomes of a preceptorship program that individualized a teaching-learning method in which a new graduate nurse was assigned a clinical expert in order to experience the day-to-day practice with a role model and a resource in the clinical setting. At the conclusion of the orientation process, the graduate nurse identified confidence in their ability to complete assigned skills, they were more motivated to remain on staff in the facility, and the retention of the new graduate nurses increased from 40% to 100% at the 1 year mark. The graduate nurses evaluated the program, the preceptor and the assigned competencies and the facility and the probability of continuing on staff. The surveys were collected by management, and evaluated for rigor, which revealed encouraging results of the program. The facilitation and integration of the preceptor program for new graduate nurses changed the perception of competency within the facility as it relates to the discipline of nursing and moves the graduate toward professional growth, establishing a changing environment in the facility's community of healthcare.

Research has found that the turnover rate of graduate nurses within their first year is significantly high. Specialties such as pediatric and emergency nursing have even a higher turnover rate. It has been suggested that significant amounts of stress and lack of skills are responsible for the turnovers. This quality improvement project, which is theoretically based on Benner's novice to expert theory, will examine if a lack of a specialized pediatric emergency graduate nurse orientation program is a contributing factor. The purpose of the project is to improve retention of graduate nurses by implementing a specialized orientation program that focuses on pediatric emergency nursing. The research question examined the effect of a specialized graduate nurse orientation program on increasing retention, nurses' competency, and job satisfaction. This project takes the hospital's original orientation program of 6 generalized classes and hands-on orientation and adds a more specialized approach. The Emergency Nurses Association (ENA) Core Curriculum of specialized skills and didactic classes for pediatric emergency nursing (developed by the ENA pediatric committee based on evidence and gold standard practice); evaluation tools (developed by researcher) for both the preceptor and orientee; and face-to-face meetings between the educator, preceptor and orientee were the tools used for specializing the orientation program. It is anticipated that the results will show that increase in retention. In terms of social change, it is anticipated increased nursing retention will increase nursing knowledge and job satisfaction, which will ultimately lead to improved patient outcomes and decreased mortality rates.

Research has shown that job satisfaction influences retention of nurses, and policies focused on nursing satisfaction are more beneficial for retaining new nurses than adjusting work hours and wages. The prophecy job fit predictor is a quality improvement initiative designed to identify where a nurse should be assigned based on behavior, clinical capabilities, and personality assessment. The practice-focused question for this project focused on whether satisfaction rates of recently graduated registered nurses were influenced by their unit placement. The conceptual frameworks that guided this project were the plan, do, study, and act method and Herzberg's 2-factor theory. Data were obtained from surveying a cohort of 54 graduate nurses in 3 hospital locations in 6 specialty units. Results obtained using 1-way ANOVA and a Likert scale showed that graduate nurse satisfaction rates increased when assigned to their best fit unit: prophecy job fit 58.33% with a mean score of 3.34 (Hospital A), prophecy job fit 20% with a mean score of 3.1 (Hospital B), prophecy job fit 33.33% with a mean score of 3.1 (Hospital C). The results showed that the prophecy job fit predictor during nursing orientation can guide nurses into the appropriate specialty unit and increase nursing satisfaction. The implications of these findings for positive social change in nursing practice include the benefits of using the prophecy job fit predictor when assigning graduate nurses to their hospital setting to address the nursing shortage.

An expectation of the nurse preceptor role includes the ability to evaluate, deliver feedback, and coach new graduate nurses. A gap in nurse preceptors' communication skills can affect the safety-related behaviors and quality of care provided by new graduate nurses, thus affecting patient outcomes. To bridge this gap, robust training on delivering feedback and coaching is needed for preceptors. The purpose of this staff education project was to develop and validate 5 communication simulation scenarios for preceptor training. Mezirow's transformative learning theory and the National League for Nurses-Jeffries simulation theory were used to guide the project. A panel of nurse leaders served as subject-matter experts who evaluated each simulation scenario and individual components using a Likert-style scoring method. Lynn's model for validation was used to determine the validity of individual components and overall scenarios. Each component and scenario scored 0.83 or higher according to Lynn's model and was deemed valid. The panel members recommended that the components and scenarios be integrated into the preceptor-training program at the project site. Incorporating the validated scenarios into a preceptor-training program might allow nurse preceptors the opportunity to practice effective communication skills in a simulation setting. Implications for positive social change include professional development for preceptors, effective training for new graduate nurses, and improved outcomes for patients.

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In a report on the nursing shortage, the American Association of Colleges of Nursing cited insufficient preceptors as one of the factors influencing the decreased intake of nursing students to registered nurse (RN) programs, thus compounding the shortage issue. The site selected for this project was a teaching hospital that annually facilitates hundreds of nursing students for clinical practice. Graduate nurses rotating through the hospital are assigned to work with RNs within their assigned units. The purpose of this doctoral project was to develop a preceptor training program for RNs in a teaching hospital. The practice-focused question examined whether RNs would identify perceived competence and understanding in the preceptor role as a result of preceptor training. Knowles'€™s adult learning theory and Benner'€™s theory of skills acquisition framed the project. Participants (N = 7) completed a 2-week didactic and clinical training in preceptorship. As a result of the educational intervention, the preceptor trainees reported an increase in knowledge, skills, and confidence in the preceptor role. Seven participants (100%) expressed that the training was interesting, relevant, beneficial to their work, and stimulated sharing. The implications of this project for positive change include the potential benefits to new and experienced graduate nurse preceptors by reducing feelings of inadequacy, stress, and burnout and enhancing job satisfaction. Additionally, graduate nurses who work with competent, confident preceptors experience less anxiety, improved job satisfaction and a smoother transition to the role of professional nurses prepared to deliver quality health care to patients. Improving preceptor-graduate nurse experiences may result in reduced turnover among nurses and improved customer experiences.

<p>With the increasing demand on the health-care system and increasing human resource shortages, the delivery of critical care services is facing a crisis. Although funding is being provided to increase the number of critical care beds to meet the physical demands, the supply of qualified registered nurses (RNs) is decreasing. To increase the required staff, new graduate RNs are being hired into critical care units more than ever before. The influx of newly graduated RNs has been deemed controversial as it is viewed that new graduates are unable to engage in complex decision-making or complete the technical skills required in critical care.</p> <p>The research objective of this study was to explore the experiences of new graduate RNs entering a critical care unit and to gain an understanding of the barriers and facilitators present when transitioning to the unit. Semi-structured interviews with eleven participants were conducted with new graduates from four critical care units within two major teaching hospitals in Southwestern Ontario. A qualitative descriptive design described by Sandelowski (2000) was used for this research study. The findings describe the experiences of new graduates including the emotional experience, the times of transition, becoming a professional, embracing team support and learning to feel comfortable within the unit.</p> <p>These findings will be of interest to a broad audience including nursing students, new graduates, hospital managers and administrators, educators and policy makers. It is anticipated that these results will help inform organizational policy and programs and will direct further research on this topic.</p> / Master of Science (MSc)

Different studies show that stress is a common feeling that newly graduated nurses experience during the first period in the profession. What causes the stress are high expectations that they have on themselves and the expectations from colleagues, as well as the fear of making a mistake while working as a nurse. Newly graduate nurses go through five stages of development from being novice to expert. The aim of this study was to describe work experiences of newly graduate nurses in hospital ward settings. The research method was a literature study based on ten qualitative articles. Articles were analyzed by using the method of Friberg (2012). Four main themes were identified: experiences of leadership; experiences of the relationship with colleagues; experiences of support; experiences of knowledge level. Colleagues and managers must respond to the needs of newly graduated nurses in an adequate way to create a friendly and supportive working environment, which in turn can contribute to the professional development of the newly graduated nurse. Nursing education should prepare students for professional careers in terms of socialization, leadership and organization.

Efforts to maintain a sufficient nurse workforce are hampered by dissatisfaction with the work environment. Incivility in the work environment is a major source of dissatisfaction. A healthy work environment is associated with higher levels of job satisfaction and improved retention. New graduate transition programs have been recommended as a deterrent to high levels of turnover associated within the first two years of employment, some of which is related to incivility. The purpose of this thesis was to examine the influence of incivility in the nursing workplace on new graduate job satisfaction and determine if there is an association between participation in new graduate nurse transition programs and satisfaction with the work environment. A systematic review of the literature was performed using MEDLINE- EBSCOhost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixteen studies, which met search criteria, were reviewed. Themes that emerged included workplace incivility, nurse residency programs, mentoring through preceptors, and empowerment. Findings indicated that incivility in the workplace was a significant predictor of low job satisfaction in new graduate nurses. While graduate nurse transition programs are associated with improved satisfaction and retention rates for these nurses, nothing in the literature indicated that graduate nurse transition programs had a direct impact on empowerment and job satisfaction related to the incivility these nurses experience.

This project, which used a qualitative, explanatory case-study design explored the transition to practice of new graduate Registered Nurses (RNs) and Registered Practical Nurses (RPNs) in long-term care (LTC). Specifically, this study focused on the self-described transition to practice experience of the new graduate nurse (NGN), the contextual factors present in LTC that influenced this transition to practice, and how the transition experience was similar and different for the new graduate RN and RPN. Both NGNs and LTC directors were included in the study. In total, 7 NGNs and 2 LTC directors participated in semi-structured interviews. The NGN participants were employed as a nurse in one of the two LTC sites and had been working as a nurse for less than one year. Data were collected through Key Informants (NGNs and LTC directors), and Key Documents (LTC policies and orientation material). Results of this study introduced six contextual factors present in LTC that influence the transition to practice of NGNs and five processes that, as a result of the contextual factors, accelerate the transition to practice experience. This described accelerated transition to practice refutes the previously universally applied transition to practice theory and contributes new knowledge and understanding to the transition to practice experience of the NGN in LTC and more specifically how the new graduate RPN experiences transitioning. The findings also described the many similarities and some differences between the transition to practice experience of the new graduate RN and RPN in LTC. With increasing demands on the long-term care sector, these findings will be of interest to a broad audience including policy makers, educators, LTC directors and administrators, as well as nursing students and NGNs. It is anticipated that these results will direct further research on this topic, and inform policy, practice, and educational programs. / Thesis / Master of Science (MSc)