<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)

<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)

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.

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.

No description available.

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.

Every year, millions of medical errors are committed, costing not only patient health and satisfaction, but thousands of lives and billions of dollars. Errors occur in many areas of the healthcare environment, including the profession of nursing. Nurses provide and delegate patient care and consequently, standard nursing responsibilities such as medication administration, charting, patient education, and basic life support protocol may be incorrect, inadequate, or omitted. Although there is much literature about errors among the general nurse population and there is indication that new nurses commit more errors than experienced nurses, not much literature asks the following question: What are the factors contributing to the commission of errors, including the omission of standard nursing care, among new nurses? Ten studies (quantitative, qualitative, and mixed-mode) were examined to identify these factors. From the 10 studies, the researcher identified the three themes of lack of experience, stressful working conditions, and interpersonal and intrapersonal factors. New nurses may not have had enough clinical time, may develop poor habits, may not turn to more experienced nurses and other professionals, may be fatigued from working too many hours with not enough staffing, may not be able to concentrate at work, and may not give or receive adequate communication. Based on these findings and discussion, suggested implications for nursing practice include extended clinical experience, skills practice, adherence to the nursing process, adherence to medications standards such as the five rights and independent double verification, shorter working hours, adequate staffing, no-interruption and no-phone zones, creating a culture of support, electronically entered orders, translation phones, read-backs, and standardized handoff reports.

La période de transition des infirmières et infirmiers nouvellement diplômés (IND) dans la pratique clinique est marquée par des défis individuels, émotionnels et professionnels. Ces défis peuvent contribuer à un épuisement professionnel et ainsi augmenter le taux d’attrition des IND dans les unités de soins. La mise en place d’un programme de résidence en soins infirmiers permet de répondre à ces défis et entraîne donc des répercussions positives au niveau individuel, professionnel et institutionnel. Toutefois, aucune revue des écrits ne recense les programmes de résidence en soins infirmiers pour les IND débutant dans le secteur des soins intensifs. Le but de cette revue de la portée est donc d’identifier et de décrire la structure des programmes de résidence en soins infirmiers pour les IND dans les unités des soins intensifs. Cette revue de la portée réalisée selon la méthode du Joanna Briggs Institute a recensé un total de 241 références, dont huit ont été retenues. L’extraction des données a été réalisée en suivant le modèle de structure de programme de résidence en soins infirmiers de Chant et Westendorf (2019) comprenant sept concepts-clés (cadre de référence, objectifs initiaux, préceptorat, mentorat, composantes didactiques, durée, immersion clinique). Quatre constats provenant des résultats obtenus ont pu être tirés et discutés: une grande disparité dans la structure des programmes de résidence, un besoin d’encadrer davantage le développement des compétences des IND par des cadres de référence et des principes pédagogiques, la nécessité de répondre aux besoins de transition des IND et le besoin de prendre en compte les ressources disponibles. Ces constats illustrent la pertinence de l’implication des formateurs et des gestionnaires pour répondre aux besoins de transition des IND sur les unités de soins intensifs. / The period of transition of new graduate nurses (NGN) into clinical practice is marked by individual, emotional and professional challenges. These challenges can contribute to a burnout and increase turnover rates for care units. The implementation of a nurse residency program for NGN transitioning into practice can address these challenges and lead to positive repercussions at individual, professional and institutional levels. The purpose of this scoping review is to identify and describe the structure of nursing residency programs for NGN in intensive care units. This scoping review using the Joanna Briggs Institute method identified a total of 241 references, of which eight were retained. The extraction followed Chant and Westendorf's (2019) structure model using seven key concepts (framework/models, defined outcomes, preceptorship, mentorship, didactic components, program length, clinical immersion). Four findings were drawn and discussed from the results obtained: a wide disparity in the structure of residency programs, a need for more guidance in the development of NGN competencies by using frameworks and pedagogical principles, the necessity to answer to the transition needs of NGN, and the need to consider the available resources. These findings highlighted the relevance of the involvement of trainers and managers to help NGN transition into intensive care units.

Indiana University-Purdue University Indianapolis (IUPUI) / Factor H is a newly identified phenomenon which describes a constellation of attributes of the new graduate nurse reflecting personality traits, intellectual abilities, and clinical judgment. In a previous pilot study conducted by this researcher nurse managers and experienced Registered Nurse (RN) preceptors described characteristics demonstrated by new graduate nurses demonstrating Factor H and the new graduate nurse’s ability to transition quickly and successfully into the RN role in the acute care environment. There is currently no instrument available to measure this phenomenon. The specific aim of this research was to develop and psychometrically test a scale designed to identify the presence of attributes of Factor H in the new graduate nurse. The Sims Factor H Assessment Scale (SFHAS) was developed and piloted with a sample of one hundred one new graduate nurses within three months of completing the their nursing program at one of three nursing schools in central and south central Indiana. Evidence of content validity was demonstrated through the use of the Content Validity Index conducted with a panel of four experts. Evidence of face validity was demonstrated through interviews with a group of new graduate nurses, nurse managers, and experienced RN preceptors. Principle Axis Factoring with Varimax rotation was used to demonstrate evidence of construct validity and the scale was found to have a single component which was identified as nursing personality. Evidence of criterion-related validity was demonstrated utilizing analysis of the SFHAS and the criterion scale for personality traits (NEO-FFI). Evidence of internal consistency reliability was demonstrated through analysis of inter-item correlations, Cronbach’s coefficient correlations, and item-total correlations. Test re-test reliability using interclass correlation was also conducted to demonstrate stability of the scale. The SFHAS was found to be reflective of nursing personality and not general mental ability or clinical judgment. Use of the SFHAS will allow organizations to evaluate the nursing personality of the new graduate nurse for fit into the work environment. Further study is recommended to gain clarity around the attributes which support successful transition of the new graduate nurse into practice in the acute care environment, also known as Factor H.