<p><strong>Background. </strong>Interprofessional collaboration is a cogent strategy to promote retention and safe, quality nursing care among new graduate nurses. This sandwich thesis describes a research project undertaken to understand how new graduate nurses engage in interprofessional collaboration.</p> <p><strong>Objective. </strong>The aim was to comprehensively understand the individual, team, and organizational factors that influence new graduate nurse engagement in interprofessional collaboration.</p> <p><strong>Methods. </strong>An integrative review of the new graduate nurse literature was conducted within the context of interprofessional collaboration. Applying the Structuration Model of Interprofessional Collaboration as a framework, a mixed methods study examined the team and organizational predictors of new graduate nurse engagement in interprofessional collaboration, and explored factors that influenced confidence among new graduate nurses toward interprofessional collaboration. Quantitative data were collected via mailed surveys. Follow-up interviews were conducted to explain the quantitative findings.</p> <p><strong>Results. </strong>The integrative review revealed individual, team, and organizational factors that were reported to influence new graduate nurse engagement in interprofessional collaboration. The review concluded a gap in the current knowledge of the issue, and literature that was weak to moderate in quality. The team and organizational predictors of new graduate nurse engagement in interprofessional collaboration were: satisfaction with the team, number of team strategies, participation in a mentorship or preceptorship experience, accessibility of manager, and accessibility and proximity of educator or professional practice leader. The interviews revealed respect, team support, and face-to-face interprofessional interactions as team facilitators. Supportive leadership and preceptorship or mentorships were organizational facilitators. Several variables had a relationship with new graduate nurse confidence in interprofessional collaboration. A model that explains this confidence was developed from the qualitative findings.</p> <p><strong>Conclusion. </strong>The Structuration Model of Interprofessional Collaboration was a valuable</p> <p>framework for understanding the structural elements of new graduate nurse engagement in interprofessional collaboration. This thesis identifies implications for education, practice and research.</p> / Doctor of Philosophy (PhD)

Tidigare forskning belyser den påfrestande tid nyutexaminerade sjuksköterskor befinner sig i under inträdet till den nya yrkesrollen. Studiens syfte var att genom intervju undersöka nyutexaminerade sjuksköterskors upplevelser av sin första introduktion. Nio sjuksköterskor deltog i studien. Under introduktionen sker ett rollbyte från student till legitimerad sjuksköterska med tillhörande ansvar. Rollbytet skapar stress och osäkerhet vilket leder till ett stort behov av stöd och samtal. Handledaren är en av de viktigaste komponenterna i denna process, dock upplevde de nyutexaminerade sjuksköterskorna brist på tid för utvecklande samtal. En god introduktion upplevs utformas av stödjande kollegor men framförallt genom sjuksköterskans egen delaktighet. Kunskapnivån samt behov hos den nyutexaminerade sjuksköterskan är individuell, därav förespråkar studiens reslutat en individanpassad introduktion vilket anses leda till en mer självsäker och kompetent sjuksköterska. / Earlier research highlights the stressful time newly graduated nurses feel during the transition into the new professional identity. The purpose of this study was to examine newly graduated nurses´ experiences of their first introduction through interviews. Nine nurses participated. During the introduction a transition appears from being a student to a registered nurse with responsibilities. The transition creates stress and uncertainty which builds up a need for support and conversa-tion. The preceptor is one of the most important components in this process. New-ly graduated nurses´ felt there was a lack of time for stimulating conversations during the introduction. A satisfying introduction is conducted by supporting col-leges but mostly by the nurses own participation. The newly graduated nurse´ knowledge and need is individual therefore the result of this study promotes an individually planed introduction. This is considered to lead to a more self-confident and competent nurse.

By 2034 there is predicted to be a shortage of between 17,800 and 48,000 physicians in primary care, (Association of American Medical Colleges, 2021). Nurse practitioners have proven to be a versatile tool in helping to bridge this gap in health care. As the need for family nurse practitioners grows so also the need for quality educational experiences for these providers must continue to expand. Currently, employment turnover rates for family nurse practitioners are twice those of physicians, (Barnes, 2015). Formal transitions into advanced practice, such as residency programming have been found to ease new family nurse practitioners into practice. However, few residency programs exist to help aid in this transition, (Flinter, 2005, 2012). This project aims to develop a program that provides educational opportunities for post-graduate family nurse practitioners as they transition to advanced practice nursing. The project will develop a nurse practitioner residency program specific to the needs of this region guided by the Social Determinants of Health. The program will provide new graduate family nurse practitioners with an opportunity to take part in a year-long post-graduate residency program. Providing an intense on-the-job training experience from veteran practitioners. This program will then be written into a grant to help fund the project in our region.

New graduate nurses (NGNs) at bedside are faced with numerous challenges, which prompt them to leave jobs in their first year. The transition from being a student to competent nurse requires a NGN to have the necessary skills and experience. Subsequently, hospitals continue to face shortages of staff because of high turnover and low retention levels. Nonetheless, evidence from reviewed literature has indicated that the use of residency programs can increase NGNs' stay at bedside, improve retention, reduce costs of operations, and return employees' turnover. The purpose of this quality improvement project was to identify the likelihood of NGNs remaining at bedside after participating in a 52 week NGN residency program in the critical care units at Palmetto Health hospital. When a hospital recruits and retains NGNs at the bedside, the quality of life among patients is improved. Benner's theory of novice to expert was utilized to understand professional growth of nurses. Data were collected from the human resource department of the 18 nurses who initially participated in the residency program to compare retention rates before and after its implementation. The project initiative was based on a quantitative non-experimental comparison design. Based on the evidence from the human resource department, there was a 14% improvement in nurse retention 3 months after the implementation of the NGN residency program. A statewide adoption of NGN residency programs was recommended to help improve retention and enhance NGNs' professional improvement and quality of care. The implementation of NGN residency program also demonstrated implications for social change through increasing retention, building nurse competency, and enhancing quality of care delivered.

Graduate nurses are being employed to provide care in high acuity care areas, and this becomes a problem of significance as the literature suggests that graduate nurse's experience a deficit in integrating theoretical concepts in the clinical environment, described as the theory-practice gap; which can result in a risk to patient safety and the potential for negative outcomes. Cognitive constructivism was the conceptual framework that guided this study. A qualitative phenomenological design was used to explore the lived experiences of 13 graduate nurses employed at a community hospital in northern New Jersey. After recruiting the participants through purposive sampling, semi-structured interviews were conducted with them utilizing a researcher-developed interview protocol based on the Casey-Fink Graduate Nurse Experience Survey. The research questions addressed the graduates' clinical experiences and their perceptions of simulation in facilitating the integration of theory to practice. Interviews were transcribed verbatim, coded, and analyzed to identify 4 themes: (a) the theory-practice gap, (b) effective educational pedagogy, (c) theory-practice integration, and (d) simulation-based learning. The crucial finding was that graduate nurses perceived the theory-practice gap could be reduced through the use of high-fidelity simulation utilizing scenario-based learning exercises in prelicensure programs prior to entry to practice. Based on these findings, the recommendations presented in a white paper will help the administration of the school of nursing at the local site make informed decisions to effect curricular changes that promote the students' integration of theory into practice. Further, the results of this study impact social change by serving as a model for similar programs to improve the preparation of graduate nurses to provide care to optimize positive patient care outcomes.

Forty years after Kramer's (1974) seminal work, Reality Shock, new graduate nurses continue to have difficulty transitioning to the registered nurse (RN) role. The purpose of this phenomenological study explores the lived experience of new graduate nurses who completed a Veterans Affairs externship program in their senior year of nursing coursework and its perceived impact on their successful transition into the practice role 3-24 months following graduation. Benner's (1984) Novice-to-Expert Model, Karmer's (1974) Reality Shock Theory, and Selder's (1989) Life Transition Theory support a framework for this study. Twelve telephone interviews were conducted using van Manen's (1990) method for researching the lived experience. One overarching theme "feeling confident" and three main categories, "transitioning to the RN role," "making decisions," and "interacting with professionals," were identified from the data. Externship programs assist the student to comfortably and smoothly transition as a new graduate nurse by offering additional clinical and practice experiences. Given the complexity of today's health care environment, there is a growing need to better prepare the graduate nurse for their transition into nursing practice. Externship programs can serve this purpose.

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Background: Newly graduate nurses experience the transition into working as a nurse as overwhelming due to a lack of work experience. Working with acutely ill patients requires readiness to act where not only adequate treatment and interventions are important but also where every second matters. Aim: The aim was to describe newly graduated nurses’ experiences of caring for acutely ill patients. Method: A literature review was carried out using Friberg’s four-step model where data from a total of nine studies with quantitative and qualitative research studies were analyzed. Results: The result emerged in two categories and five sub-categories that indicated that newly graduated nurses feel unprepared and insecure in handling and treating acutely ill patients. They question their ability to care for their patients and are afraid of making mistakes which may cause harm to the patient. Newly graduated nurses also felt an urge to take control of the acute situation. The five sub-categories are as followed: fear of making mistakes, feeling unprepared, take control, feelings of inadequacy and lastly questioning one’s ability. Conclusion: Collegial support and having a preceptor were crucial factors that facilitated newly graduated nurses to adequately care for acutely ill patients. By giving the right support to newly graduate nurses they feel less afraid, stressed and less overwhelmed. Readiness to act was found to be something that a nurse developed over time and by experiencing acute situations. / Populärvetenskaplig sammanfattning Att börja arbeta som nyexaminerad sjuksköterska kan vara utmanande, särskilt vid vård av akut sjuka patienter som kan bli försämrade väldigt hastigt. Akuta situationer kräver snabba åtgärder vilket kan upplevas extra påfrestande för den nya sjuksköterskan. Akut sjuka patienter kan påträffas oavsett vilken typ av arbetsplats som sjuksköterskan är verksam inom, och snabbt insättande åtgärder och en tillgänglig vård kan minska miljontals dödsfall och funktionsnedsättningar världen över. Den här litteraturöversikten utgick från ett sjuksköterskeperspektiv och hade som syfte att beskriva hur nyexaminerade sjuksköterskor upplevde att vårda akut sjuka patienter. Studiens resultat bestod av nio vetenskapliga artiklar och påvisade chockartade upplevelser där de nyexaminerade sjuksköterskorna var oförberedda och var rädda för att göra misstag. De strävade också efter att skapa kontroll i den akuta situationen, vilket kunde uppnås genom stöd från kollegor och erfarenhet av akuta situationer. Resultatet beskrev också upplevelser av att inte kunna möta kraven i det nya yrket med känslor där den nyexaminerade sjuksköterskan ifrågasatte sin egen förmåga och kände sig otillräcklig. I bakgrunden beskrevs sjuksköterskeprofessionen och dess kärnkompetenser, vidare beskrevs akutsjukvård och de vårdvetenskapliga begreppen “vårdande” och “handlingsberedskap” som kan relateras till akutsjukvård. I metoden användes totalt nio vetenskapliga artiklar, varav sex kvalitativa, två kvantitativa och en med både kvalitativ och kvantitativ metod. I diskussionen diskuterades nyexaminerade sjuksköterskors reaktioner på akuta situationer och olika typer av påverkan som kollegor kan ha. Stöd från kollegor och en tilldelad handledare var faktorer som möjliggjorde för den nyexaminerade sjuksköterskan att vårda akut sjuka patienter. Rätt stöd minskade rädsla, stress och gjorde sjuksköterskan mindre överväldigad.

Bakgrund: Antalet njurtransplantationer har under de senaste åren ökat i Sverige. För patienter med CKD-5 är det den säkraste åtgärden för att kunna leva ett längre och bekvämare liv. En njurtransplantation från en levande donator bidrar till bättre återhämtning och längre liv. Den grundutbildade sjuksköterskan behöver ha god insikt i ämnet njurtransplantation för att ge god och säker vård, både medicinskt och omvårdnadsmässigt. Syfte: Syftet med denna litteraturstudie är att utforska patienters upplevelser i väntan på njurtransplantation med en levande donator. Metod: I litteraturstudien används tio vetenskapliga artiklar med kvalitativ metod.  Resultat: Resultatet belyser två huvudteman, förväntningar i väntan samt förändrade relationer. Deltagarna i studien upplevde känslor som hopp, oro, förhoppning om att kunna återgå till ett normalt liv samt skuld. Mottagarnas upplevelser varierade beroende på vilken relation de hade till donatorn. Slutsats: Det är viktigt för den grundutbildade sjuksköterskan att ge korrekt omvårdnad och god information till patienten. Sjuksköterskan kan bidra till god omvårdnad genom stöttande samtal och att initiera kontakt mellan donator och mottagare. Mottagarna upplever levande njurtransplantation som livsomvälvande, och många olika känslor och funderingar väcks till liv. / Background: The number of kidney transplants has increased in Sweden in recent years. Kidney transplantation is the safest measure for patients living with CKD-5, it prolongs and leads to a better life. A kidney donation from a living donor contributes to better recovery and a longer life. The graduate nurse needs good insight regarding the subject of kidney transplantation to be able to provide adequate and safe care, both in the aspect of medicine and care. Aim: The aim of this literature study is to explore patients' experiences while waiting for a kidney transplantation from a living donor.  Method: In this literary study ten scientific articles were used with a qualitative method. Results: In the result two main themes arose, Expectations in waiting and Changing relations. The participants of this study experienced feelings of hope, worry, hope of getting back to a normal life and guilt. Recipients' experiences varied depending on what relation they had to the donor. Conclusion: It is of importance to the graduate nurse to provide just care and correct information to the patient. The nurse is able to contribute to just care through supportive conversation and initiating contact between the donor and the recipient. The recipient perceives waiting for kidney transplantation as life changing, and many diverse feelings appear.

Bakgrund: Sjuksköterskeyrket är en profession med komplexitet där den professionella sjuksköterskan bör inneha kunskap och förståelse, färdighet och förmåga, värderingsförmåga och förhållningssätt, för att kunna leda och ansvara för en god patientsäker omvårdnad. Det examineras ungefär 5000 sjuksköterskor varje år i Sverige. Sjuksköterskestudenter som närmar sig examen upplever blandade känslor. Både en glädje över att snart vara färdiga sjuksköterskor, en oro över att inte besitta kompetens nog för rollen samt en osäkerhet inför att arbeta självständigt och att ansvara för beslut i patientrelaterade omvårdnadsfrågor. Efter två år i yrket väljer 30 % av de nyutexaminerade sjuksköterskorna att lämna yrket. Syfte: Syftet var att få en fördjupad förståelse av nyutexaminerade sjuksköterskors erfarenheter av sitt första år inom professionellt kliniskt arbete. Metod: Metoden som används är en litteraturöversikt som baseras på elva artiklar bestående av två med mixad metod, en av kvalitativ design samt sju med kvantitativ studiedesign med Benners (1984) teori från Novis till Expert som stöd som vid resultatdiskussion. Resultat: Den nyutexaminerade sjuksköterskans erfarenheter sammanfattas under fyra huvudteman: Rollförväntningar, Arbetskultur och Miljö, Utvecklande av kompetens samt Fokusskifte. Undertema till Rollförväntningar är Osäkerhet och Kaos. Undertema till Arbetskultur och Miljö är Introduktion och Handledning. De nyutexaminerade sjuksköterskorna hade förväntningar på rollen som sjuksköterska som ledde till en skrämmande erfarenhet i den kliniska verksamheten. Positiva erfarenheter hos de nyutexaminerade sjuksköterskorna var förenade med att ha en bra handledare och en stödjande arbetsmiljö. Efter att utövat professionen i nästan ett år upplevde de nyutexaminerade sjuksköterskorna en tillfredsställelse med utvecklingen av yrkeskompetensen. Under de första sex till tolv månaderna koncentrerade de nyexaminerade sjuksköterskorna sina krafter på lära känna den nya arbetsmiljön och erhålla acceptans från arbetskollegor. Vart efter trygghet i rollen växte, skiftade sjuksköterskan fokus från sina egna behov till patientens. Diskussion: Resultatet diskuterades med stöd av Benners teori. Resultatet visade på att flertalet av de nyutexaminerade sjuksköterskorna inte uppfattade sig redo att självständigt agera, hantera och organisera omvårdnaden och upplevde ett behov av mer empirisk erfarenhet för att hantera sin roll som sjuksköterska. De nyutexaminerade sjuksköterskorna var i behov av stöd vilket även Benner beskriver i sin teori. Att uppleva stöd från arbetskollegor och andra sjuksköterskor med mer gedigen erfarenhet var ytterst viktiga faktorer för den nyutexaminerade sjuksköterskans hälsa och kompetensutveckling, men flertalet av studierna visade på att nyutexaminerade sjuksköterskor upplevde att de saknade stöd. Den nyutexaminerade sjuksköterskan koncentrerar sig på den egna utvecklingen samt att följa utstakade riktlinjer, vilket kan orsaka att patienten hamnar i bakgrunden för den nyutexaminerade. Det är först när den nyutexaminerade sjuksköterskan skaffat sig tillräckligt med erfarenheter och självförtroende hen skiftar fokus från sina egna behov till patientens. / Background: The nursing profession is a profession with complexity where the professional nurses must have knowledge and understanding, skills and abilities, judgment and approach, to be able to lead and be responsible for good and safe patient care. Approximately 5000 nurses graduate every year in Sweden. Nursing students approaching graduation experienced mixed feelings. Both a delight to soon be finished nursing while concern was expressed about not possessing the skills enough for the role, as well as an uncertainty to work independently and be responsible for decisions in patient-related health issues. After two years in the profession approximately 30 % of the newly graduated nurses choose to leave the profession. Aim: The aim was to gain a deeper understanding of how the newly graduated nurses experience their first year in the professional clinical work. Method: The method used is a literature review based on eleven articles consisting of two with mixed method, one of qualitative design and seven with quantitative study design with Benner's (1984) theory from Novis to Expert as support for discussion of the results. Results: Four major themes emerged: Role Expectations, Work Culture and Environment, Development of expertise and Focus shift. Subthemes to Role Expectations is Uncertainty and Chaos. Subthemes to Work Culture are Environment's Introduction and Mentoring. The newly graduated nurses had expectations about the nursing role that led to a terrifying experience in clinical practice. Positive experiences of the graduate nurses were associated with having a good supervisor and a supportive work environment. After practicing the profession for nearly a year, the newly graduated nurses experienced satisfaction with the development of the professional skill. During the first six to twelve months the newly graduated nurses concentrated their energy on getting to know the environment and receive acceptance from colleagues. When security grew in the nursing role, the nurse shifted the focus from their own needs to the patient's needs. Positive experiences of the newly graduated nurses were associated with having a good supervisor and a supportive work environment. Discussion: The results were discussed with Benners theory. The results showed that the majority of the newly graduated nurses did not perceive themselves ready to act independently, manage and organize care, and felt a need for more empirical experience to handle the nursing role. The newly graduated nurses stated a need for support from an experienced nurse, in which Benners agrees and describes in her theory. Experience support of colleagues and other nurses with more experience was extremely important factors for the newly graduates health and development of competence, but most of the studies showed that newly graduated nurses felt that they lacked support. As the competence increased the newly graduated nurse experienced that their previous focus on getting acceptance from colleagues was replaced by a focus on the patient and their care. According to Benners theory the newly graduated nurses concentrate on their own development and guidelines, which can cause the newly graduated nurse to lack focus on the patient.